[Restorative proctocolectomy with an ileoanal pouch. Postoperative course and long-term functional results].

INTRODUCTION: Over the last 25 years restorative proctocolectomy with an ileoanal pouch has been the gold standard in the surgical treatment of ulcerative colitis and in selected patients with familial adenomatous polyposis. We present a study of the course, complications and long-term functional results.

MATERIALS AND METHODS: A prospective cohort analysis and a questionnaire in 178 consecutive patients operated since 1987 in Hvidovre Hospital.

RESULTS: Postoperative complications were seen in 38 patients (21%), but only few were serious: anastomotic leakage in 2 (1%), pelvic abscess in 4 (2%) and complications after ileostomy closure in 2 (1%). The late complications comprised reoperation for intestinal bowel obstruction in 10 (6%), pouch fistula in 6 (3%), pouchitis in 22 (12%), and anastomotic stricture in 8 (5%). Three patients (2%) had the pouch removed. After a median observation period of 7 years (range 1-19) the patients had a median of 7 bowel movements per 24 hours (range 3-15), and 2/3 were totally continent day and night. 88% were satisfied with the results.

CONCLUSION: Our results are similar to those in the literature, probably because the preoperative evaluation, operation, postoperative course and long-term follow-up were managed by few specialists in ileoanal pouch surgery. In our opinion restorative proctocolectomy with an ileoanal pouch is still the gold standard for patients with ulcerative colitis and for selected patients with familial adenomatous polyposis.