Clinical Results of One-stage Restorative Proctocolectomy with J-pouch Anal Anastomosis in 300 Ulcerative Colitis Patients

• Main Authors: Ryuichi Kuwahara, Hiroki Ikeuchi, Toshihiro Bando, Hirohumi Sasaki, Yoshiko Goto, Yuki Horio, Tomohiro Minagawa, Motoi Uchino
• Format: Article
• Language: English
• Published: The Japan Society of Coloproctology 2020-10-01
• Series: Journal of the Anus, Rectum and Colon
• Subjects: ulcerative colitis; restorative proctocolectomy; without diverting ileostomy
• Online Access: https://www.jstage.jst.go.jp/article/jarc/4/4/4_2020-003/_pdf/-char/en

Objectives: Restorative proctocolectomy and ileal pouch anal anastomosis (IPAA), with diverting ileostomy, are established ulcerative colitis (UC) treatments. The routine use of diverting ileostomy is controversial because of the risk of stoma closure and stoma related complications. In our institution, proctocolectomy and IPAA, with mucosectomy and handsewn anastomosis without diversion (one-stage IPAA), were performed for select patients with UC. The present study aimed to evaluate the clinical and functional outcomes of patients undergoing one-stage IPAA. Methods: Between April 1999 and July 2017, 300 patients underwent one-stage IPAA in our institution. The clinical notes and prognosis were reviewed retrospectively. Results: Postoperative complications (Clavien-Dindo classification grade III) occurred in 18 patients (6.0%). The most common complication was anastomotic leakage (n = 9, 3%). There were 15 patients (5.0%) who required a defunctioning ileostomy. However, 13 patients successfully underwent ileostomy closure and achieved acceptable pouch function. Finally, two patients (0.6%) required pouch excision in this series. The cumulative pouch functional rate was 99.6% / 5 years and 99.2% / 10 years. Conclusions: One-stage IPAA is a good strategy for carefully selected patients with UC.