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Salvage surgery after restorative proctocolectomy. BJS 2003; 90: 909-921.

Published: 1st August 2003

Authors: H. Tulchinsky, C. R. G. Cohen, R. J. Nicholls

Results

Failure after restorative proctocolectomy results from complications, which may occur indefinitely during follow‐up to a cumulative rate of about 15 per cent at 10–15 years. Sepsis accounts for over 50 per cent of these complications. Abdominal salvage procedures are successful in 20 to over 80 per cent of patients but the rate of salvage is dependent on the duration of follow‐up, which might explain this variance. Local procedures are successful in 50–60 per cent of patients with pouch–vaginal fistula. Poor function accounts for about 30 per cent of failures. Abdominal salvage for outlet obstruction and low pouch capacitance results in satisfactory or acceptable function in up to 70 per cent of patients. There is no effective surgical salvage for pouchitis.

Conclusion

Salvage surgery must be discussed carefully with the patient, who should be made aware of the possible complications and the prospect of success, which is less than that in the general population of patients undergoing ileoanal pouch surgery. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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