ArticleColorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland2026
Restorative versus non-restorative total proctocolectomy: Who doesn't pouch and how do they do?
Article in Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aimLiterature comparing total proctocolectomy with permanent end ileostomy (TPC-EI) and IPAA in patients with UC is sparse. We aimed to (a) elucidate reasons for non-restorative surgery in ulcerative colitis (UC), (b) describe the incidence of perineal wound complications and (c) assess differences in short-term outcomes between groups. We hypothesized that non-restorative surgery was associated with a higher overall complication rate than ileoanal pouch (IPAA).
methodsWe identified a sample of patients with UC who underwent proctectomy (2005-2023) at our institution. The primary endpoint was the overall 30-day complication rate. Odds ratios (ORs) and 95% confidence intervals are presented.
resultsA total of 821 patients were included: 689 (83.9%) IPAA and 132 (16.1%) TPC-EI (80% and 52% staged proctectomy, respectively). The most common reasons for TPC-EI over IPAA were patient preference (53%), neoplasia (10.6%), incontinence (9.1%) and obesity (7.6%). Compared with IPAA patients, TPC-EI patients were older, had more comorbidities, and more were receiving biologics. Postoperatively, 18.2% of TPC-EI patients developed perineal wound complications, whereas 4.5% of IPAA patients experienced leaks. The overall 30-day complication rate was higher after TPC-EI (37.1% vs. 19.2%, p < 0.0001); however, after excluding these procedure-specific complications, rates were equivalent (22.7% vs. 17.9%, p = 0.23). In multivariable analysis after propensity score matching, TPC-EI remained a significant predictor of any complication (OR 2.84, 95% CI 1.37-6.08, p = 0.006).
conclusionsPatient preference was the most common reason for permanent ileostomy in UC. Although short-term complication rates were similar overall, perineal complications occurred in 18% after TPC-EI. These data may inform preoperative counselling when discussing surgical options for UC.
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