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Objective: Total proctocolectomy with ileal pouch-anal anastomosis is considered the procedure of choice for patients requiring elective surgery for ulcerative colitis (UC). But some patients undergoing subtotal colectomy with end ileostomy (STC) for acute disease are satisfied with an ileostomy and do not request a pelvic pouch. The timing and need for completion proctectomy (TPC) in this setting is uncertain. The aim of this study was to assess symptoms and complications related to the retained rectum.
Design: Retrospective review of a prospective database.
Setting: Academic medical center.
Patients: Patients who underwent subtotal colectomy with ileostomy for ulcerative colitis from 7/90-12/10
Main Outcome Measures: Proctectomy, surgical complications, symptoms from retained rectum
Results: 108 patients underwent subtotal colectomy for UC during the study period: 73 for acute disease, 18 with advanced age/comorbidities and 17 to avoid the risk of sexual dysfunction or infertility. 71 (66%) of these pts underwent IPAA and 2 died from other causes within two years of surgery; 3 were lost to followup . Of the remaining 32 patients, 20 chose rectal stump surveillance and 12 underwent elective proctectomy at a median of 2.6 years later. There was no difference in age, gender, surgical complications or pad use between the two groups. In the surveillance group, 5.9% had rectal urgency, 11.8% rectal pain and 50% rectal bleeding; two required proctectomy at 11 and 16 years respectively for rectal cancer; neither has developed recurrent disease. One patient in each group reported erectile dysfunction.
Conclusion: Management of the retained rectum after subtotal colectomy remains an important issue even in the era of IPAA. Proctectomy did not increase the surgical complication rate or risk of urinary/erectile dysfunction.