The impact of the development of restorative proctocolectomy on the management of inflammatory bowel disease in the north of Scotland.

In the North of Scotland, 40 out of 196 patients who had surgery for colitis between 1986 and 1992 underwent restorative proctocolectomy. The problems of the development of experience in a new technique were reduced by cooperation between two consultant surgeons from centres 100 miles apart who performed the first 30 operations together. Over 7 years, the standard operative technique evolved from perimuscular dissection of the rectum with formation of an S pouch and hand sutured endo-anal anastomosis to perimesenteric rectal dissection with a stapled J pouch and double stapled anastomosis. There was no mortality and no pelvic sepsis requiring urgent re-operation. One pouch has been removed subsequently because of Crohn's disease. One patient required revisional surgery for severe stricture of the ileo-anal anastomosis. At 1 year post-operatively, 35 out of 40 patients were highly satisfied with the result of surgery. The proportion of patients undergoing restorative proctocolectomy rather than panproctocolectomy for ulcerative colitis has risen from 15 to 52%. The number of total colectomies performed as initial procedures for colitis has increased. The age of patients who have restorative proctocolectomy has widened to include teenagers as well as a few patients over 50 years of age.