Review Article: restorative proctocolectomy, indications, management of complications and follow-up: a guide for gastroenterologists

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http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2036.2008.03643.x

Alimentary Pharmacology & Therapeutics

OnlineAccepted Articles (Accepted, unedited articles or abstracts published online for future issues)

To cite this article: S. D. MCLAUGHLIN, S. K. CLARK, P. P. TEKKIS, P. J. CICLITIRA, R. J. NICHOLLS Review Article: restorative proctocolectomy, indications, management of complications and follow-up: a guide for gastroenterologists Alimentary Pharmacology & Therapeutics (OnlineAccepted Articles). doi:10.1111/j.1365-2036.2008.03643.x

Review Article: restorative proctocolectomy, indications, management of complications and follow-up: a guide for gastroenterologists

S. D. MCLAUGHLIN1,2,41Department of Biosurgery and Surgical Technology, Imperial College London.2Department of Gastroenterology, St. Mark’s Hospital, London,4Nutritional Sciences, King’s College London, School of Biomedical and Health Sciences, Rayne Institute, St ’ Hospital, London,, S. K. CLARK33Department of Surgery, St. Mark’s Hospital, London,, P. P. TEKKIS11Department of Biosurgery and Surgical Technology, Imperial College London., P. J. CICLITIRA5 & R. J. NICHOLLS11Department of Biosurgery and Surgical Technology, Imperial College London..

1Department of Biosurgery and Surgical Technology, Imperial College London.2Department of Gastroenterology, St. Mark’s Hospital, London,3Department of Surgery, St. Mark’s Hospital, London,4Nutritional Sciences, King’s College London, School of Biomedical and Health Sciences, Rayne Institute, St ’ Hospital, London,

Correspondence to:Dr SD McLaughlin,Department of Gastroenterology,St. Mark’s Hospital, Watford road, Harrow, London HA1 3UJ.simon.mclaughlin@...

Authors appointments and places of workDr SD McLaughlin, Research Fellow, St. Mark’s Hospital, Imperial College and King’ College, LondonMiss SK , Consultant Colorectal surgeon, St. Mark’s Hospital, LondonMr PP Tekkis, Senior lecturer and Consultant Colorectal surgeon, Imperial College, St. ’s Hospital, London.Prof PJ Ciclitira, Professor of Gastroenterology and Consultant Gastroenterologist, Guy’s and St. ’ Hospitals, King’s College London.Prof RJ Nicholls, Visiting Professor of Surgery, Imperial College London

Abstract

Background: Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis is the procedure of choice for the majority of patients with ulcerative colitis who require surgery. Over 2,500 patients in the UK have undergone RPC. It is now increasingly being performed in district general hospitals as well as in specialist IBD units. Gastroenterologists are increasingly involved in the management of patients following RPC.

Aim: To provide gastroenterologists with a clear understanding of the investigation and evidenced-based management of complications and the aftercare required in patients who have undergone RPC.

Results: Following RPC most patients have an excellent long-term functional outcome. Pouchitis, pelvic sepsis and poor function are the most common causes of failure. The development of cancer is rare, nevertheless long-term follow up is required.

Conclusions: The investigation and management of patients who develop complications requires a multi-disciplinary team approach in order to optimise the outcome. Protocols are suggested for investigation and management of patients with complications and for long term cancer surveillance.