One-stage restorative proctocolectomy without temporary ileostomy for ulcerative colitis

TLDR

The study aimed to assess the safety of performing restorative proctocolectomy without a temporary defunctioning ileostomy in ulcerative colitis patients. One hundred consecutive ulcerative colitis patients underwent elective restorative proctocolectomy with pouch‑anal anastomosis, half receiving a defunctioning ileostomy and half proceeding with a one‑stage procedure without ileostomy. While operative mortality was zero and overall complication rates were similar, the no‑ileostomy group experienced significantly more life‑threatening events—11 cases of pelvic sepsis and 7 reoperations versus 7 sepsis and no reoperations in the ileostomy group—leading to the conclusion that omitting the ileostomy is not recommended.

Abstract

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 ileostomy (P<0.01). CONCLUSION: One-stage restorative proctocolectomy without a defunctioning ileostomy is associated with increased risk to life. Its routine use cannot be recommended.