J Korean Soc Coloproctol.  2009 Jun;25(3):207-211. 10.3393/jksc.2009.25.3.207.

Controversies in Pouch Surgery for Ulcerative Colitis

• Yu CS

• KMID: 1966634
• DOI: http://doi.org/10.3393/jksc.2009.25.3.207

Abstract

Restorative proctocolectomy (RPC) has become a standard procedure over 30 yr in patients with ulcerative colitis and familial adenomatous polyposis. However, there are several controversies in surgical method and strategy. From oncological point of view, mucosal proctectomy and hand-sewn ileal pouch anal anastomosis has advantage because of relatively complete removal of columnar epithelium. However, long-term follow-up results after stapled anastomosis revealed extremely low incidence of dysplasia in the anal transitional zone (ATZ). Furthermore, recent publication of 26 cancer occurrence after RPC showed more prevalence in mucosectomy group. Risk factors of dysplasia after RPC are supervening cancer or dysplasia on the proximal colon, long duration of symptom, and history of primary sclerosing cholangitis. Preservation of ATZ by stapled anastomosis may have functional superiority, which is supported by some manometric and functional studies. However, two randomized controlled trials showed no difference between the groups. Although there are some surgeons who advocate one stage RPC, majority of centers prefer two stage RPC with ileostomy. According to meta-analysis one stage RPC revealed 2-3 times frequent anastomotic leakage or pelvic sepsis. Five to ten percent of ulcerative colitis has some pathologic characteristics of Crohn's disease, which is classified as indeterminate colitis (IC). Long-term results of RPC in patients with IC revealed similar results with ulcerative colitis and superior to Crohn's disease. So RPC may be justified in patients with IC. Conclusively, RPC should be tailored according to clinicopathologic details and operative findings.

Keyword

Ulcerative colitis; Mucosectomy; Stapled anastomosis; Ileostomy; Indeterminate colitis

MeSH Terms

Adenomatous Polyposis Coli
Anastomotic Leak
Cholangitis, Sclerosing
Colitis
Colitis, Ulcerative
Colon
Crohn Disease
Epithelium
Follow-Up Studies
Humans
Ileostomy
Imidazoles
Incidence
Nitro Compounds
Prevalence
Proctocolectomy, Restorative
Publications
Risk Factors
Sepsis
Ulcer
Cholangitis, Sclerosing
Imidazoles
Nitro Compounds