Surgery after colectomy for ulcerative colitis.

The need for surgery after colectomy in patients with ulcerative colitis in Stockholm County over a 30-year period, 1955 to 1984, was investigated. During this time 483 patients were discharged from the hospital after colectomy. The mean period of observation from colectomy was 11.6 years. In 325 (67 percent) of the 483 patients there was need for further surgery (932 surgical procedures) during the period of observation. In 95 (20 percent) patients 115 small intestinal obstructions requiring surgery developed. The 2-year and 15-year cumulative probabilities of a first small intestinal obstruction were 11 percent (confidence intervals [CI] 8-14 percent) and 23 percent (CI 19-27 percent), respectively. In 42 (16 percent) of 255 patients treated by proctocolectomy and ileostomy there was need for 64 ileostomy revisions. The 2-year and 15-year cumulative probabilities of a first ileostomy revision were 9 percent (CI 6-12 percent) and 19 percent (CI 14-24 percent), respectively. Ninety-one Kock's pouches were constructed and a total of 125 revisions of Kock's pouch were performed. The 2-year and 15-year cumulative probabilities of a first Kock's pouch revision were 52 percent (CI 41-63 percent) and 57 percent (CI 46-68 percent), respectively. In 75 patients a pelvic pouch and ileoanal anastomosis was constructed. In 32 patients 73 surgical procedures due to pouch-related dysfunction were performed. Alterations in ileoanal pouch technique and increasing surgical experience has resulted in a markedly decreasing frequency of complications during the last years. There was no need for further surgery in 116 (45 percent) of the 255 patients treated by proctocolectomy and ileostomy, in 31 (34 percent) of the 91 patients with Kock's pouch, in 20 (39 percent) of the 51 patients with ileorectal anastomosis, and in 43 (57 percent) of the 75 patients with pelvic pouch and ileoanal anastomosis (closure of loop ileostomy excluded).