Multivariate analysis of factors influencing the results of restorative proctocolectomy

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Abstract
Univariate and multivariate analyses have been used to assess the influence of 14 variables on the results of 65 consecutive ileoanal pouch procedures over 5 years. There were nine failures requiring intubation, ileostomy or pouch excision. There was a significant association between failure and pelvic sepsis (P <0·05, n = 8), endoanal mucosectomy (P <0·05, n = 7), preservation of a long rectal cuff (P <0·05, n = 5) and lack of experience with the operation (P <0·05, n = 8). Of 49 patients with preoperative evidence of ulcerative colitis, three are now known to have Crohn's disease. Functional outcome was significantly impaired in patients who developed pelvic sepsis (P <0·01) or a postoperative fistula (P <0·05), and who had an endoanal mucosectomy (P <0·05). Success with ileoanal pouch reconstruction increases with experience. Avoidance of sepsis is associated with a lower failure rate, improved functional results and reduced hospital stay. Preliminary colectomy is also advised to exclude Crohn's disease if the diagnosis is in question.