Analysis of the Results of Surgical Treatment Options for Ulcerative Colitis

Park, Kyu Joo; Park, Gahb

Abstract

The surgical options for ulcerative colitis have developed rapidly in recent years, with emphasis on improving the quality of life by preservation of voluntary defecation and continence while eradicating the disease. In this paper, we have retrospectively analyzed 29 patients with pathologically proven ulcerative colitis who underwent surgical treatment at the Department of Surgery, Seoul National University Hospital between 1980 and 1996. We sought to correlate the changing patterns of the surgical management with their outcomes. The mean age at the time of definitive surgical procedures was 36.7(+/-11.9), and median duration of follow-up was 26 months. The final surgical procedures performed in these patients were ileal J pouch-anal anastomosis (14), total proctocolectomy with either end (7) or continent ileostomy (4), total colectomy with ileorectal anastomosis (1) or Hartmann procedure (2), and partial colectomy (1). Since 1993, we have been performing ileal pouch-anal anastomosis(IPAA), which was performed in all patients except two (one with toxic colitis and the other with disseminated colon cancer). In two patients who underwent partial colectomy and were available for follow-up, there was recurrence of symptoms related to ulcerative colitis. All 11 patients who received total proctocolectomy with either end or continent ileostomy experienced at least one postoperative complication, and 5 required reoperations for management of these complications. Tn particular, 3 out of 7 patients who received total proctocolectomy with continent ileosotmy required removal of the pouch due to pouch related complications. There were two postoperative deaths due to septic complications. On the other hand, while 8 out of 14 patients who received IPAA experienced postoperative complications, all were resolved with conservative management and none required reoperation. The function of ileal J pouch was assessed in 13 Patients at a median duration of 10 months (range : 3~27 months) after restoration of pouch continuity. The mean stool frequency per 24h was 7.6(+/-2.1) and mean nocturnal stool frequency was 1.6(+/-1.5). None of the patients had major incontinence while 7 had occasional spotting of mucous. The remaining 6 patients had normal continence. Only one patient needed antidiarrheal medication and 5 followed a strict diet. Confirmed pouchitis occurred in only one patient. All of the patients who received IPAA were satisfied with their bowel status and the operation. Our results confirm that IPAA is an acceptable surgical option for the management of ulcerative colitis.