PURPOSE: PURPOSE:This study was designed to determine the safety of omitting a temporary defunctioning ileostomy in restorative proctocolectomy for ulcerative colitis.
METHOD: METHOD:One hundred consecutive patients with ulcerative colitis were treated electively by restorative proctocolectomy and pouch-anal anastomosis, without mucosal stripping; 50 had a defunctioning ileostomy added, and 50 underwent a one-stage procedure without ileostomy.
RESULTS: RESULTS:There was no operative mortality. The incidence of postoperative complications was similar in the two groups of patients. Lifethreatening complications, however, were more common among patients who did not have a defunctioning ileostomy, of whom 11 developed pelvic sepsis and 7 required reoperation. Among patients with an ileostomy, seven developed pelvic sepsis but none required reoperation (P<0.02). Emergency reoperations were required in 11 patients without an ileostomy but in only 1 patient with an ileostomy (P<0.01).
CONCLUSION: CONCLUSION:One-stage restorative proctocolectomy without a defunctioning ileostomy is associated with increased risk to life. Its routine use cannot be recommended.
Read at the meeting of The American Society of Colon and Rectal Surgeons, Orlando, Florida, May 8 to 13, 1994.
© The ASCRS 1997