Abstracts
1997 Digestive Disease Week

Restorative protocolectomy without diverting ileostomy is safe.

S Parangi, S Beanes, RE Lehman, S Barbour, TR Schrock, ML Welton. University of California, San Francisco, San Francisco, CA.

Purpose: To establish the impact of diverting loop ileostomy on perioperative complications, length of hospitalization, and patient satisfaction following a stapled ileoanal J pouch procedure for ulcerative colitis or familial polyposis.

Methods: We reviewed records of a 120 consecutive patients treated with double stapled ileoanal J pouches for ulcerative colitis (113) or familial polyposis (7) from 1990 to 1995. Patients in group I (n=54) were treated with double stapled J pouches and diverting loop ileostomies; 25/54 (46%) of group I patients had a mucosectomy. As a result of a change in surgical treatment policy, consecutive patients in group II (n=66) were treated with stapled ileoanal anastomoses without diverting ileostomy. Six group II patients required an ileostomy at initial operation because of concern for potential anastomotic leak; these patients were not included in this review. Quality of life surveys were sent to all patients with a 67% response rate. Unpaired student's t test was used for statistical comparison.

Results: Groups I and II were statistically comparable in age (mean 42 vs 37), duration of disease (12 vs 10 years) and indication for operation. However, fewer group I patients had undergone colectomy prior to the ileoanal procedure and a larger percentage of them were on greater than 20 milligrams of prednisone per day (40 vs 21 percent). Average follow-up was 5 vs 3 years for groups I and II respectively. Number of days hospitalized for the ileoanal procedure was significantly longer for group I patients (mean 11.4, range 8-26) than group II patients (mean 10. range 7-18, p<0.05). Group I patients had a longer duration of operation (3.5 vs 3 hours, p<0.05), and more intraoperative blood transfusions (0.2 vs 0.02 units, p<0.05). There were no significant differences between groups I and II in number of early complications exclusive of ileus (33 vs 18 percent), number of late complications (33 vs 33 percent), subsequent operations exclusive of ileostomy takedown (0.55 vs 0.50 per patient). or subsequent hospital days (5.2 vs 3.9). Group I patients had less postoperative ileus (7 vs 39 percent, p<0.05). Groups I and II had leak rates of 11% and 5%; and pouch excision rates of 11% and 5% respectively. There were no differences in survey response rates, frequency of stools, general health scores, or overall patient satisfaction in those responding to the survey.

Conclusion: Restorative proctocolectomy with double stapled ileoanal anastomosis without a diverting loop ileostomy is a safe operation. Patients without ileostomies experienced longer ileus, but with no prolongation of hospitalization. Patients without diverting ileostomies did not have higher rates of late complications, pouch excision or dissatisfaction. We conclude that diverting loop ileostomy is not necessary when performing a restorative proctocolectomy.