Total colectomy and ileo-rectal anastamosis versus total procto-colectomy and Ileo-anal [j] pouch anastamosis for ulcerative colitis

The aim of this study is to compare the outcome of two sphincter-saving operations for ulcerative colitis namely total colectomy and ileorectal anastamosis [TC-1R] retrospectively with total procto-colectomy and ileo-anal [j] pouch anastamosis [TC-IA] prospectively. Surgery was indicated in 89[7.84%] among 1135 patients with ulcerative colitis of these; 57 subjected to TC-IR [Group A] during period 1968-1990 and 32 to TPC-IA [Group B] between 1991-2005, by Z R Al-Bahrani at the Medical City Teaching Hospital and Al-Mustansiria Private Hospital, Baghdad. Of these 89 patients, 41 were males and 48 were females. Mean [range] age in years was 35.5 +/- 13.3 [12-65]. Indications for surgery were; intractability 59[66.2%], carcinoma 13[14.6%], toxic colon 8[9%], sever bleeding 7[8%] and intestinal obstruction 2[2.2%] patients. The type of colitis were; pan-colitis 72[81%], left colitis 16[17.9%] and procto-sigmoiditis one [1.1%] patient. Pseudo-polyposis was seen in 52[58.5%] patients. The outcome of Group A [57 patients] were; post-operative mortality 2[3.5%], 1-3 complications minor and/or major in 31[53.4%] patients. After operation; normal defecation, bowel motion/day reduced from 8 to 5 [P<0.001], body weight/Kg increased from mean 53 to 62.5 [P<0.001] and the Hb gm/dl rose from mean 10.2 to 12.2 [P<0.001]. The outcome of Group B [32 patients]: post-operative mortality 1[3.1%], 1-3 complications minor and/or major in 16[50%] patients. After operation; control on defecation took few weeks-months to settle, bowel motion/day was reduced from a median 10 to 5 [P<0.001], body weight/kg increased from mean 52.9 to 56.2 [P=0.59[ns], and Hb gm/dl rose by a mean 03[P=0.68[ns]. Both surgical operations are super major and carry potential risk of complications and should be advised when medical treatment fails or serious complications of the disease arise which risk the patient's life or interfere with his normal life. Both procedures improve bowel motion, general health and quality of life without incontinence but total procto-colectomy and ileo-anal with pouch is considered superior to total colectomy and ileor-rectal anastomosis because excluding to a great extent the risk of rectal cancer