SEARCH · PubMed Health

Results for “Proctocolectomy, Restorative”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 91 records · Page 5Linked to original sources

PubMed1996

Joint symptoms after restorative proctocolectomy in ulcerative colitis and familial polyposis coli.

We have determined the incidence and nature of joint symptoms in patients who had a restorative proctocolectomy and ileal reservoir for ulcerative colitis (UC) and familial adenomatous polyposis (FAP); we also have recorded the effect of drug treatment and surgery on these symptoms. One hundred seventy-three patients with UC and 25 patients with FAP who had undergone a restorative proctocolectomy answered a questionnaire about joint symptoms. These were present in 96 (55%) patients with UC and five (20%) with FAP. In the 69 patients with UC with joint symptoms before proctocolectomy, 31 (45%) reported improvement after colectomy. However, in 27 (28%) patients with UC and joint symptoms, and four of five patients with FAP with joint symptoms, these started after restorative proctocolectomy. A family history of joint symptoms did not predispose to the development of arthropathy in the patients with UC but may have in patients with FAP. Before colectomy, in most patients with colitis, azathioprine or sulfasalazine did not improve joint symptoms, but steroids were effective in 18 of 64 patients who had received them. Of 101 patients (43%) with joint symptoms in either disease, 43 had symptoms sever enough to interfere with daily activities. We conclude that joint symptoms are a major cause of morbidity in patients with UC. After restorative proctocolectomy they may develop de novo in patients with either UC or FAP.

Adenomatous Polyposis Coli↗

PubMed2003

Long-term failure after restorative proctocolectomy for ulcerative colitis.

OBJECTIVE: To establish the incidence and causes of late failure in patients undergoing restorative proctocolectomy for a preoperative diagnosis of ulcerative colitis was the objective of this investigation. SUMMARY BACKGROUND DATA: Restorative proctocolectomy is the elective surgical procedure of choice for ulcerative colitis. Most patients have a satisfactory outcome but failures occur. The reasons and rates of early failure are well documented, but there is little information on long-term failure. METHODS: A series of 634 patients (298 females, 336 males) underwent restorative proctocolectomy for inflammatory bowel disease between 1976-1997, with a mean follow-up of 85 +/- 58 months. Failure was defined as removal of the pouch or the need for an indefinite ileostomy. It was divided into early and late, occurring within 1 year or more than 1 year postoperatively. RESULTS There were 3 (0.5%) postoperative deaths, leaving 631 patients for analysis. Of these, 23 subsequently died (disseminated large bowel cancer, 12; unrelated causes, 9; related causes, 2). There were 61 (9.7%) failures (15 early [25%], 46 late [75%]) due to pelvic sepsis (32 [52%]: 7 early, 25 late), poor function (18 [30%]: 2 early, 16 late), pouchitis (7 [11%]: 2 early, 5 late) and miscellaneous (4, all early). A final diagnosis of Crohn's disease, type of reservoir (J,S), female gender, postoperative pelvic sepsis and a one-stage procedure were significantly associated with failure. Failure rate rose with time of follow-up from 9% at 5 years to 13% at 10 years. CONCLUSIONS: Pelvic sepsis and poor function were the main reasons for later failure. Failure rates should be reported based on the duration of follow-up.

Adolescent↗

PubMed2004

Benefits of hand-assisted laparoscopic restorative proctocolectomy: a comparative study.

PURPOSE: Hand-assisted laparoscopic colectomy is thought to facilitate colonic mobilization while maintaining the benefits of laparoscopic surgery. Although previous studies of hand-assisted colectomy have focused on segmental colonic resection, the use of hand-assisted laparoscopic restorative proctocolectomy has not been investigated. This study evaluated the effectiveness of hand-assisted laparoscopic approach compared with a conventional laparoscopic method in patients undergoing restorative proctocolectomy. METHODS: From a prospective database, a consecutive series of patients were identified undergoing conventional and hand-assisted laparoscopic restorative proctocolectomy and results were compared. Twenty-three patients, comprising 10 hand-assisted and 13 conventional laparoscopic patients, were identified. Patient characteristics, perioperative parameters, and outcomes were assessed. RESULTS: Both groups were well matched with no differences in age, gender, body mass index, operative indication, diagnosis, comorbidity, or steroid usage. There were no differences among incision size between the hand-assisted (8 (range, 8-20) cm) and conventional laparoscopic cases (8 (range, 5-10) cm). The median operative time was significantly shorter in the hand-assisted group (247 (range, 210-390) minutes) compared with the conventional laparoscopic group (300 (range, 240-400) minutes; P < 0.01). The length of stay was similar between groups (hand-assisted: 4 (range, 3-13) days vs. conventional: 6 (range, 4-17) days). Complications occurred in four hand-assisted patients (40 percent; 2 ileus, mechanical obstruction, and dehydration) and in four patients undergoing conventional laparoscopic method (31 percent; 2 anastomotic leak, ileus, and mechanical obstruction). CONCLUSIONS: Compared with conventional laparoscopic restorative proctocolectomy, the hand-assisted method resulted in a significant reduction in operative time without detriment to bowel function, length of stay, or patient outcome. The hand-assisted approach to restorative proctocolectomy is likely to replace conventional laparoscopic methods as the preferred laparoscopic approach for this technically challenging procedure.

Adolescent↗

PubMed1992

Temporary loop ileostomy following restorative proctocolectomy.

A retrospective study compared the outcome of restorative proctocolectomy in patients who had a covering ileostomy (n = 53) with those who had no proximal stoma (n = 32). Those who had a loop ileostomy had a higher incidence of anastomotic leakage (21 per cent), pelvic abscess (32 per cent) and postoperative fistula (28 per cent) than those with no covering ileostomy (6, 12 and 12 per cent respectively). Intestinal obstruction occurred in 23 per cent of those with an ileostomy, compared with 6 per cent in those who had no stoma. The functional outcome was identical.

Abscess↗

PubMed2004

Health-related quality of life after restorative proctocolectomy for ulcerative colitis: long-term results.

Restorative proctocolectomy (RPC) is the favorite operation for ulcerative colitis, but it may influence health-related quality of life (HRQL). Our aims were to determine the long-term HRQL of patients and its modifications after a 5-year follow-up and to identify any risk factor for a worse outcome. We enrolled 36 patients submitted to RPC (mean follow-up 8.4 +/- 4.7 years), 36 ulcerative colitis (UC) patients, and 36 healthy subjects. We used a previously validated questionnaire that explored bowel symptoms, systemic symptoms, emotional function, and social function. A series of 17 patients had completed the same questionnaire 5 years earlier. Clinical and surgical factors were investigated. Statistical analysis was performed with Student's t-test, Wilcoxon matched-pairs test, and Fisher's exact test. The scores of the RPC patients were significantly better than those of moderate or severe UC patients, similar to those with remission/mild UC, and higher than those of the controls. The scores of patients interviewed 5 years earlier did not change in the present study, except for patients during the first postoperative year, in whom the scores were now significantly better. The analysis of RPC patients in subgroups showed that the use of drugs, high stool frequency, pouchitis, pelvic complications, and younger age at UC diagnosis worsened the HRQL outcome. We concluded that RPC patients, after a long-term follow-up, had an HRQL similar to that of the remission/mild UC patients. Recently operated patients improved their quality of life mainly because of improved emotional function, and patients who had been operated on for a longer time maintained their HRQL. HRQL is influenced by drugs, stool frequency, pouchitis, postoperative pelvic complications, and age at diagnosis.

Activities of Daily Living↗

PubMed2004

Treatment of rectal cuff inflammation (cuffitis) in patients with ulcerative colitis following restorative proctocolectomy and ileal pouch-anal anastomosis.

BACKGROUND: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the treatment of choice in the majority of patients with ulcerative colitis (UC) who require surgery. To ease the construction of the IPAA and improve functional outcome by minimizing sphincter related stretch injury, a stapling technique is being commonly used in the pouch-anal anastomosis. Despite its advantages, the procedure normally leaves a 1-2 cm of anal transitional zone or rectal cuff, which is susceptible to recurrence of residual UC or cuffitis. Cuffitis can cause symptoms mimicking pouchitis. AIM: To conduct an open-labeled trial of topical mesalamine in patients with cuffitis. METHODS: We treated 14 consecutive patients with cuffitis by giving mesalamine suppositories 500 mg b.i.d. (mean 3.2 months, range 1-9 months). The Cuffitis Activity Index (adapted from the Pouchitis Disease Activity Index) scores and improvement in symptoms of bloody bowel movements and arthralgias were measured as primary and secondary outcomes. RESULTS: All patients had surgery for medically refractory UC. There were significant reductions in the total Cuffitis Activity Index scores after the therapy (11.93 +/- 3.17 vs 6.21 +/- 3.19, p < 0.001). Symptom (3.24 +/- 1.28 vs 1.79 +/- 1.31), endoscopy (3.14 +/- 1.29 vs 1.00 +/- 1.52), and histology (4.93 +/- 1.77 vs 3.57 +/- 1.39) scores each were significantly reduced (p < 0.05). Ninety-two percent of patients with bloody bowel movements and 70% of patients with arthralgias improved after the therapy. No systemic or topical adverse effects were reported. CONCLUSION: Topical mesalamine appears well tolerated and effective in treating patients with cuffitis, with improvement in symptom as well as endoscopic and histologic inflammation.

Adult↗

PubMed2001

Salvage abdominal surgery in patients with a retained rectal stump after restorative proctocolectomy and stapled anastomosis.

BACKGROUND: The introduction of surgical stapling instruments has widened the use of restorative proctocolectomy. Too high a distal transection of the rectum can, however, produce a retained rectal stump, which may cause symptoms. A study of the operative and functional data in a consecutive series of patients undergoing salvage surgery for retained rectal stump was undertaken. METHODS: Twenty-five patients referred between January 1990 and September 2000 for pouch dysfunction were identified as having a retained rectal stump. Twenty-two underwent abdominoanal revision. The hospital notes were reviewed and function was assessed during outpatient visits, by postal questionnaire and by telephone interview. RESULTS: Median operating time was 225 (range 170-340) min and median hospital stay was 15 (range 8-48) days. There was no operative death. Five pouches were excised. Seventeen patients were available for functional assessment. Median follow-up was 22.5 (range 4-114) months. Median 24-h frequency before and after operation was 12 (range 4-20) and 6 (range 3-12) respectively, and median night-time frequency was 4 (range 0-8) and 0.5 (range 0-4) respectively. Fifteen patients reported marked subjective improvement in pouch function and quality of life. CONCLUSION: Major revisional surgery for symptomatic retained rectal stump after restorative proctocolectomy with stapled anastomosis was successful in 15 of 22 patients. These results are worse than the outcome following first-time restorative proctocolectomy with anastomosis constructed at the anal level. Pouch-rectal anastomosis should be avoided.

Adenomatous Polyposis Coli↗

PubMed1993

Carriage of adhesive Escherichia coli after restorative proctocolectomy and pouch anal anastomosis: relation with functional outcome and inflammation.

Restorative proctocolectomy with pelvic ileal reservoir is a well accepted option for the surgical treatment of ulcerative colitis. Acute pouchitis is a common complication and resembles acute ulcerative colitis. Patients with ulcerative colitis carry Escherichia coli that adhere to epithelial cells and thus this study examined whether acute pouchitis is associated with the carriage of adhesive E coli. E coli isolated from stool samples from 24 patients (median age 34 years, range 16-64; 13 men, 11 women) who had had restorative proctocolectomy with pelvic ileal reservoir were examined by means of the buccal epithelial cell adhesion assay. Patients were studied at a median of 12 months (range 7-21) after operation. Eight of 24 patients had acute pouchitis at the time of study. Adhesive E coli were detected in nine of 24 patients with a pelvic ileal reservoir compared with none of 12 controls (p < 0.05). The buccal epithelial cell adhesion index was inversely related to the degree of acute pouchitis (rs = 0.46, p = 0.024) and to the functional outcome (rs = -0.49, p = 0.022). Carriage of adhesive E coli was not related to the design of the reservoir. By contrast with ulcerative colitis, acute pouchitis is not associated with the carriage of adhesive E coli.

Adolescent↗

PubMed2006

The outcome after restorative proctocolectomy with or without defunctioning ileostomy.

PURPOSE: Controversy exists regarding the safety for omission of diverting ileostomy in restorative proctocolectomy because of fears of increased septic complications. This study was designed to evaluate the outcomes of restorative proctocolectomy in a consecutive series of patients by comparing postoperative complications, functional results, and quality of life in patients with and without diverting ileostomy. METHODS: Data regarding demographics, length of stay, surgical characteristics, and complications were reviewed and recorded according to the presence (n= 1,725) or absence (n = 277) of a diverting ileostomy at the time of pelvic pouch surgery. Criteria for omission of ileostomy included: stapled anastomosis, tension-free anastomosis, intact tissue rings, good hemostasis, absence of airleaks, malnutrition, toxicity, anemia, and prolonged consumption of steroids. Functional outcome and quality of life indicators were prospectively recorded and compared. RESULTS: Patients in the ileostomy group had greater body surface area and older mean age at time of surgery, were taking greater doses of steroids preoperatively, and required more blood transfusions at the time of surgery compared with the one-stage (P < 0.05). There were no differences between the two groups in septic complications (P > 0.05). Early postoperative ileus was more common in the one-stage group (P < 0.001). There were no differences between the groups in quality of life and functional outcomes. CONCLUSIONS: For carefully selected patients undergoing restorative proctocolectomy with ileal pouch-anal anastomosis, omission of diverting ileostomy is a safe procedure that does not lead to an increase in septic complications or mortality. Quality of life and functional results are similar to those who undergo ileal pouch-anal anastomosis with diversion, provided that certain selection factors are considered.

Adenomatous Polyposis Coli↗

PubMedDate not supplied

Ileal-pouch-anal anastomosis after restorative proctocolectomy in patients with ulcerative colitis or familial adenomatous polyposis.

BACKGROUND/AIMS: Restorative proctocolectomy is the "golden standard" in surgical treatment of ulcerative colitis and familial adenomatous polyposis. The two alternative techniques of ileal-pouch-anal anastomosis include hand-made suture and double line stapled suture. The aim of the study was the analysis of postoperative complications and functional results of the two types of anastomosis. METHODOLOGY: Analyzed group consisted of 71 patients operated between 1994 and 2003 for ulcerative colitis (n=62) or familial adenomatous polyposis (n=9). Stapled anastomosis was performed in 56 (79%) cases whereas hand-made suture was performed in 15 (21%) cases. RESULTS: No significant differences between the two anastomosis techniques were found in terms of postoperative complications as well as late functional results. CONCLUSIONS: The low rate of complications and well accepted functional outcome prove that restorative proctocolectomy is a safe surgical procedure which may be offered to patients with ulcerative colitis of familial adenomatous polyposis. Double line stapled suture should be the preferred method of ileal-pouch-anal anastomosis, however hand-made suture remains its valuable alternative and may be considered in selected cases.

Adenomatous Polyposis Coli↗

PubMed1996

Sexual function following restorative proctocolectomy in women.

PURPOSE: This study was undertaken to identify the incidence and type of sexual dysfunction experienced by women after undergoing restorative proctocolectomy. METHODS: A questionnaire was sent to 262 females who underwent restorative proctocolectomy by a single surgeon from 1984 to 1993. The response rate was 35 percent (92/262). Additional information was gained from our pelvic pouch data base. Mean follow-up was 43 (6-130) months. RESULTS: Following surgery, a significant increase was found in vaginal dryness, dyspareunia, pain interfering with sexual pleasure, and limiting of sexual activity because of concerns of stool leakage. There was no significant change in sexual desire, arousal, sensitivity, frequency of intercourse, or satisfaction with sexual relationship. CONCLUSION: Potential sexual dysfunction following restorative proctocolectomy in women merits discussion in preoperative counseling with the patient.

Adult↗

PubMed1988

Restorative proctocolectomy for ulcerative colitis.

The results of 36 restorative proctocolectomies (with 2-loop reservoir) for ulcerative colitis (UC) performed in a three-year period were surveyed. These patients represented 69% of all those undergoing definitive surgery for UC at the same time at our department. There was no operative mortality. Both early (44.4%) and late complications (45.2%) were quite common, but they were mostly minor and only two were permanent failures (5.6%) requiring construction of conventional ileostomy. Anastomotic retraction and sinus formation (25%), as revealed by pouch x-ray, were the most frequent early complications, occurring in a lesser degree (19.4%) also after stoma closure. Pouchitis was also a common (20%) late complication, but usually resolved promptly with metronidazole treatment. The functional results in the 23 patients evaluated were satisfactory, with a mean defaecation frequency of 5.4 per 24 hour and a minor soiling frequency of 36%. None of the patients had to wear a pad. The over-all results are compatible to those from other centres and suggest that acceptable anal function follows restorative proctocolectomy in most suitable cases with UC. The role of adequate surgical experience and consideration of contraindications must, however, be emphasised, and the surgeon must be ready to handle many minor and even major complications.

Adolescent↗

PubMed1995

[Restorative proctocolectomy. A morphological-functional study by computed tomography with coronal scans].

Restorative proctocolectomy with ileal pouch has become the surgical treatment of choice for patients with ulcerative colitis and familial polyposis of the colon. Defecography is the radiologic technique commonly used to obtain detailed information on function and morphology of the ileal pouch, but it fails to depict the pelvis. Computed Tomography (CT), with coronal images only was used to examine 10 patients with ulcerative colitis, submitted to restorative proctocolectomy. Coronal CT, yielding a panoramic view of the pelvis, represent an effective alternative technique to defecography. In fact, the two techniques provide comparable information relative to the ileal pouch; coronal CT also depicts the possible thickening of pouch walls and of pelvic fat tissue. Coronal CT also depicts the continence of ileo-anal and ileo-ileal anastomoses and the functional changes of the perineal muscles at rest and during squeezing. Coronal CT images allow easy and clear detection of such major postoperative complications as pelvic inflammation and fistulae (less frequently stenosis or dehiscences of the anastomosis).

Adult↗

PubMed2003

Long-term results of salvage surgery for septic complications after restorative proctocolectomy: does fecal diversion improve outcome?

PURPOSE: Septic complications related to the ileal pouch-anal anastomosis after restorative proctocolectomy have been reported in up to 16 percent of patients in major series. Management strategies are not well established. The aim of this study was to evaluate the results of salvage surgery and to assess the impact diversion had on the outcome. METHODS: Patients who developed ileal pouch-anal anastomosis-related septic complications after restorative proctocolectomy were identified from a prospectively maintained database. Surgical procedures and follow-up data were obtained at the time of hospital and office visits. Successful salvage was defined as the absence of clinical evidence of fistula, sinus, or abscess at least three months after salvage surgery or closure of ileostomy. RESULTS: Fifty-one patients with ileal pouch-anal anastomosis-related sepsis were identified. All patients had sinus or fistulous tracts from pouch-anal anastomoses. Eighty-nine salvage procedures were performed among these 51 patients (range, 1-4 procedures per patient). Forty-eight transanal anastomotic revisions were performed in nondiverted patients. Thirty-seven transanal revisions and four abdominoperineal revisions were performed in diverted patients. At a median follow-up of 65.2 (range, 3 to 166) months after salvage surgery or closure of the diverting stoma, 21 patients (41 percent) had complete resolution of their septic problems. Bowel frequency and continence for these patients were similar to patients who had not had ileal pouch-anal anastomotic problems. Eleven (29.7 percent) of 37 transanal procedures with diversion succeeded, whereas 10 (20.8 percent) of 48 nondiverted procedures succeeded. This difference was not significant (11/37 vs. 10/48; P = 0.448). None of the four abdominoperineal revisions succeeded. Of 51 patients, 34 (66.7 percent) retained their pouches and 21 (41.2 percent) were successfully revised. Seventeen patients (33.3 percent) had pouch excision. Five (9.8 percent) had persistent fistulas and remained diverted, and 8 (15.7 percent) had persistent fistulas and were not diverted. Thus, pouch function was retained in 29 patients (56.9 percent). CONCLUSIONS: This study shows that anastomotic failure after restorative proctocolectomy is associated with a high rate of pouch failure. Ileal pouch-anal anastomosis-related fistula or sinus warrants an aggressive surgical approach in selected, highly motivated patients because acceptable functional results are possible. Multiple procedures may often be necessary to achieve complete healing. Successful repair can be achieved after one or more unsuccessful attempts. Repeat procedures can be performed safely without adversely affecting ultimate outcome.

Abscess↗

PubMed1991

Comparison of morbidity and function after colectomy with ileorectal anastomosis or restorative proctocolectomy for familial adenomatous polyposis.

Restorative proctocolectomy with an ileal reservoir (RPC) should prevent colorectal cancer in patients with familial adenomatous polyposis. Until this is confirmed its role compared with total colectomy and ileorectal anastomosis (IRA) will depend on the relative morbidity and postoperative bowel function after the two procedures. This was analysed in 99 patients (37 RPC, 62 IRA) operated on between 1977 and 1989. Morbidity was greater after RPC with subsequent ileostomy closure (median hospital stay, 24 versus 11 days; complications, 60 versus 21 per cent; reoperation, 29 versus 3 per cent; return to normal activity; 31 versus 14 weeks). There was little difference in bowel function; after IRA median frequency was 3/24 h and urgency (unable to wait 15 min) occurred in 50 per cent, compared with 4.5/24h and 17 per cent after RPC. Night evacuation occurred in 10 and 43 per cent respectively. IRA was performed in younger patients (median 19 versus 31 years) who had fewer bowel motions before operation (2 versus 5/24 h). The greater morbidity of RPC suggests that it should be restricted to patients at higher risk of developing later rectal cancer, including those unavailable for follow-up and those with large or confluent rectal polyps or with curable colon cancer at the initial colectomy.

Adenomatous Polyposis Coli↗

PubMed1991

[Restorative proctocolectomy].

Indications and procedures of restorative proctocolectomy in the surgical treatment of ulcerative colitis and familial polyposis are reported. Surgical procedure and some technical innovations are discussed.

Adenomatous Polyposis Coli↗

PubMed1995

High dose loperamide suppositories: a novel approach for improving clinical function after restorative proctocolectomy.

The effect of loperamide suppositories on patients following restorative proctocolectomy was studied by means of a randomized, double-blind, crossover trial comparing active suppositories (20 mg b.d. x 1 week) with placebo. Ten patients (8 male, 2 female; 7 J pouch, 3 W pouch; 8 ulcerative colitis, 2 familial adenomatous polyposis) were studied 3-60 months (median, 31.5) after ileostomy closure. Ages ranged from 24 to 63 years (medium, 41.5). All patients kept a diary of their bowel habits and eight underwent a standardized test of pouch compliance. Urgency volume (UV) and maximum tolerable volumes (MTV) and the volume at onset of large isolated pouch contractions (LIC) were recorded. Statistical analysis was by the Wilcoxon test for paired data. Mean daily stool frequency during the placebo phase ranged from 3.7 to 7.8. It was reduced during the active phase in only seven patients (P > 0.1) but was reduced in all six patients whose placebo phase stool frequency was five or more. Urgency volume was increased by use of active suppositories in six of the eight patients tested (P > 0.01). There was no consistent effect on MTV. Large isolated pouch contractions were not seen in either test in one patient. In all of the remaining seven patients LIC were recorded after the placebo phase. After the active phase LIC first appeared at higher volumes in three but were not seen at all in four patients. High dose loperamide suppositories suppress pouch contractions and tend to lower stool frequency especially when high initially. They represent a novel therapeutic approach to high stool frequency in pouch patients.

Adult↗

PubMed2000

Observations in the blood lipid profile in patients undergoing restorative proctocolectomy.

BACKGROUND: Ileal dysfunction, and resection or exclusion may affect intestinal bile acid resorption resulting in alterations in serum lipid concentration. In restorative proctocolectomy, the different procedures may involve the ileum in all three ways. AIM: The aim of the present study was to analyse possible changes of the blood lipid profile during the different steps of restorative proctocolectomy operative procedure. METHOD: There were nineteen elective patients on their ordinary diet and 19 emergency patients on total parenteral nutrition. The former group were primarily operated on with colectomy; ileoanal pouch and loop ileostomy while the later group had had an emergency colectomy and terminal ileostomy before the pouch operation. Thirty five of the patients had ulcerative colitis, 2 had familial colon polyposis and 1 familial cancer syndrome. Blood specimens were collected in the mornings with the patients in a fasting state. The emergency patients were on unchanged ordinary diet during the preoperative period. Serum cholesterol and triglyceride were determined by enzymatic methods. Lipoproteins, studied only in the elective patients, were analysed by a combination of ultracentrifugation and precipitation. Student's t-test with Bonferroni's correction for multiple comparisons was used for statistic calculations. RESULTS: Preoperatively, the emergency group had significantly lower serum cholesterol but not serum triglycerides values compared to the elective group. This finding is probably due to difference in the preoperative nutrition. The cholesterol levels among patients who received steroids in the two groups were compared and found to be significantly lower in the emergency group. Later, no significant differences concerning cholesterol and triglycerides were found between the groups. The cholesterol level was not significantly different in the elective group between patients who receive hydrocortisone and those who did not. During the period with loop ileostomy cholesterol was significantly lowered while the triglycerides were significantly increased compared to the preoperative values of the elective group. The decrease of serum cholesterol levels was correlated to the length of the excluded ileum. During the same period alpha-lipoprotein decreased significantly and reached values below the normal of the reference material. Beta-lipoproteins, which were subnormal already preoperatively, increased but not significantly. Pre-beta-lipoproteins were at the same level at all stations. At 12 months with functioning pouches all analysed values, with the exception of beta-lipoproteins. were within the normal limits set by the reference material. In the emergency group the patterns for triglycerides and cholesterol were similar but for the preoperatively depressed cholesterol values. After 12 months with functioning pouch the serum cholesterol and triglycerides were at the same level as for the elective patients. CONCLUSION: A serum lipid profile was studied in patients undergoing restorative proctocolectomy. Serum cholesterol and alpha-lipoprotein decreased and triglycerides increased when the patients had a diverting loop ileostomy. At 12 months after it's closure and with a functioning pouch, the patients had the same profile as the elective patients preoperatively, and with exception of beta-lipoproteins within normal limits in spite of the loss of the colon and the construction of a pouch of the distal ileum.

Adolescent↗