Abstract
BACKGROUND—Chronic distal colitis may cause troublesome symptoms and alter quality of life. When medical treatment fails to control symptoms, patients and doctors are often reluctant to consider surgical resection because of the relatively small portion of the large bowel affected by the disease. AIM—To assess the outcome of restorative proctocolectomy (RP) in patients with distal colitis who required surgery for chronic debilitating symptoms and failed medical management. PATIENTS/METHODS—From 1986 to 1996, of 263 patients receiving RP for ulcerative colitis, 27 (16 men) were operated on for distal ulcerative colitis limited to the rectum and sigmoid colon. Bowel function and quality of life were compared before and one year after RP. RESULTS—The mean (SD) duration of ulcerative colitis was 11 (6) years. RP was performed at a mean age of 46 (10) years. All the pouches were J-shaped, and a diverting loop ileostomy was always performed. Mean (SD) hospital stay was 25 (10) days. Seven complications occurred in six patients. Previously unknown severe dysplasia was discovered on the colectomy specimen in two patients. After RP there was a significant decrease in mean (SD) daytime stool frequency (8.2 (4) v 4.7 (2), p<0.05), night-time stool frequency (2 (2) v 1 (1), p = 0.05), and the number of patients with urgency to defecate (26/27 v 1/27, p<0.001). Sex life was improved in eight patients, social life in 26, and professional life in eight. Twenty six patients were satisfied with the results, and 25 wished that they had received surgery earlier in the course of their disease. CONCLUSION—RP can improve bowel function and quality of life in patients with disabling chronic symptoms of distal ulcerative colitis. Keywords: proctocolectomy; ulcerative colitis; bowel; quality of life
Full Text
The Full Text of this article is available as a PDF (75.3 KB).
Figure 1 .
Comparison of performance status with regard to travel. Overall distribution of performance scores before and one year after restorative proctocolectomy are shown. Higher scores were obtained after the operation (p<0.01; Wilcoxon signed rank test).
Figure 2 .
Comparison of performance status with regard to sexual function. Overall distribution of performance scores before and one year after restorative proctocolectomy are shown. Higher scores were obtained after the operation (p<0.05; Wilcoxon signed rank test).
Figure 3 .
Comparison of performance status with regard to recreation. Overall distribution of performance scores before and one year after restorative proctocolectomy are shown. Higher scores were obtained after the operation (p<0.05; Wilcoxon signed rank test).
Figure 4 .
Comparison of performance status with regard to social activities. Overall distribution of performance scores before and one year after restorative proctocolectomy are shown. Higher scores were obtained after the operation (p<0.05; Wilcoxon signed rank test).
Figure 5 .
Comparison of performance status with regard to work. Overall distribution of performance scores before and one year after restorative proctocolectomy are shown. Higher scores were obtained after the operation (p<0.01; Wilcoxon signed rank test).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Fazio V. W., Ziv Y., Church J. M., Oakley J. R., Lavery I. C., Milsom J. W., Schroeder T. K. Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg. 1995 Aug;222(2):120–127. doi: 10.1097/00000658-199508000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hanauer S. B. Medical therapy of ulcerative colitis. Lancet. 1993 Aug 14;342(8868):412–417. doi: 10.1016/0140-6736(93)92819-f. [DOI] [PubMed] [Google Scholar]
- Lennard-Jones J. E. The clinical outcome of ulcerative colitis depends on how much of the colonic mucosa is involved. Scand J Gastroenterol Suppl. 1983;88:48–53. [PubMed] [Google Scholar]
- Mortensen N. Restorative proctocolectomy--the pouch operation: good or bad? Scand J Gastroenterol Suppl. 1992;192:130–135. [PubMed] [Google Scholar]
- Pemberton J. H., Kelly K. A., Beart R. W., Jr, Dozois R. R., Wolff B. G., Ilstrup D. M. Ileal pouch-anal anastomosis for chronic ulcerative colitis. Long-term results. Ann Surg. 1987 Oct;206(4):504–513. doi: 10.1097/00000658-198710000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pemberton J. H., Phillips S. F., Ready R. R., Zinsmeister A. R., Beahrs O. H. Quality of life after Brooke ileostomy and ileal pouch-anal anastomosis. Comparison of performance status. Ann Surg. 1989 May;209(5):620–628. doi: 10.1097/00000658-198905000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sagar P. M., Lewis W., Holdsworth P. J., Johnston D., Mitchell C., MacFie J. Quality of life after restorative proctocolectomy with a pelvic ileal reservoir compares favorably with that of patients with medically treated colitis. Dis Colon Rectum. 1993 Jun;36(6):584–592. doi: 10.1007/BF02049866. [DOI] [PubMed] [Google Scholar]
- Samarasekera D. N., Stebbing J. F., Kettlewell M. G., Jewell D. P., Mortensen N. J. Outcome of restorative proctocolectomy with ileal reservoir for ulcerative colitis: comparison of distal colitis with more proximal disease. Gut. 1996 Apr;38(4):574–577. doi: 10.1136/gut.38.4.574. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Schwarz R. J., Pezim M. E. Failure of right-sided coloanal anastomosis for treatment of left-sided ulcerative colitis. Report of a case. Dis Colon Rectum. 1991 Jul;34(7):618–621. doi: 10.1007/BF02049904. [DOI] [PubMed] [Google Scholar]
- Varma J. S., Browning G. G., Smith A. N., Small W. P., Sircus W. Mucosal proctectomy and colo-anal anastomosis for distal ulcerative proctocolitis. Br J Surg. 1987 May;74(5):381–383. doi: 10.1002/bjs.1800740518. [DOI] [PubMed] [Google Scholar]