Restorative proctocolectomy - a nine year experience at the King Faisal specialist hospital

Abstract

Introduction: Inflammatory bowel disease and Familial Adenomatous Polyposis (FAP) are relatively uncommon in Gulf Arabs. Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is a surgical method for treating patients with mucosal ulcerative colitis (MUC) and FAP. This paper documents a small experience with this operation in Saudi Arabia. Methods: The charts of all patients who had either MUC or FAP and in whom an IPAA had been performed were identified and were examined in order to determine patient demographics, timing and staging of operation, operative and long term morbidity and mortality and pouch function. Results: Thirty patients underwent IPAA. There were 16 males. 29 pouches were J-pouches. 1 patient was lost to follow up. Surgery was performed for fulminating MUC in 9 patients, failed medical treatment in 12, FAP in 7 and megacolon in 2. An emergency-three stage IPAA was performed in 10 patients. 3 patients received perioperative TPN. 17 were on steroid medication. 12 developed transient anastomotic stricture. 8 developed small bowel obstruction during follow up but none needed further surgery. 1 patient developed ′pouchitis′. Two pouches were removed. The mean daily and nocturnal bowel frequency was 6 and 2 motions per day. 6 patients suffered nocturnal leakage. Conclusion: The operation of restorative proctocolectomy can be performed safely, for the few patients who needed the operation in Saudi Arabia.

Keywords

• Mucosal ulcerative colitis
• Familial Adenomatous Polyposis
• restorative proctocolectomy