PURPOSE: This study was designed to determine the safety of omitting a temporary defunctioning ileostomy in restorative proctocolectomy for ulcerative colitis. 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: 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=""> (
P
<0.01). conclusion:="" one-stage="" restorative="" proctocolectomy="" without="" a="" defunctioning="" ileostomy="" is="" associated="" with="" increased="" risk="" to="" life.="" its="" routine="" use="" cannot="" be="">.
Key words
Restorative proctocolectomy
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Ulcerative colitis
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Ileostomy
Read at the meeting of The American Society of Colon and Rectal Surgeons, Orlando, Florida, May 8 to 13, 1994.