Abstract
To study the long-term effects of restorative proctocolectomy with J-pouch for ulcerative colitis 100 consecutive patients were examined a mean of 5.6 years after ileal pouch-anal anastomosis (IPAA). Seventythree percent of patients were on steroids and 22% had a preceding severe attack of colitis before IPAA. The overall early and late complication rates were 40% and 33%, respectively. Failure rate was 5% and all failures requiring pouch excision occurred within the first three post-operative years. Pouchitis (36%) was the commonest late complication. A preceding severe attack of colitis was an important prognostic sign of late anastomotic complications, troublesome incontinence and ultimate failure. The daily mean stool frequency varied from 4.5 to 6.9. After a short learning period continence — stabilised and minor incontinence was common (57%). The majority of patients (72%) were either very satisfied or had no problems in daily activities after IPAA. Ten patients were dissatisfied after surgery due to obvious medical reasons in most of them.
Résumé
Afin d'étudier les effets à long terme de la procto-colectomie avec rétablissement de la continuité par une poche en J en cas de colite ulcéro-hémorragique, 100 patients consécutifs ont été examinés en moyenne à 5,6 ans après l'anastomose iléo-anale. Avant l'intervention chirurgicale, 73% des patients étaient soumis à un traitement aux stéroïdes et 22% avaient présenté une poussée aiguë de colite. Le taux global de complications précoces et tardives est respectivement de 40 et 33%. Le taux d'échec était de 5% et la totalité des échecs ayant nécessité une excision de la poche sont survenus au cours des trois premières années post-opératoires. La pouchite (36%) constitute la complication tardive la plus fréquente. Une poussée aiguë de colite avant la chirurgie représente un important signe pronostique d'un risque de complications anastomotiques tardives, d'incontinence, voire d'échec thérapeutique. La fréquence quotidienne des selles varie de 4,5 à 6,9. Après une période d'apprentissage de la continence, la situation se normalise et une incontinence mineure est observée chez 57% des patients. La majorité des patients (72%) était soit très satisfaite, soit n'avait aucun problème dans leurs activités quotidiennes. Dix patients étaient mécontents après la chirurgie pour des raisons médicales de manière évidente dans la plupart des cas.
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Mikkola, K., Luukkonen, P. & Järvinen, H.J. Long-term results of restorative proctocolectomy for ulcerative colitis. Int J Colorect Dis 10, 10–14 (1995). https://doi.org/10.1007/BF00337578
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DOI: https://doi.org/10.1007/BF00337578