Ulcerative Colitis Treated by Ileostomy and Excisional Surgery Fifteen Years' Experience at St. Mark's Hospital

Abstract The results of excisional surgery with the eastablishment of a permanent ileostomy in 246 patients with ulcerative colitis operated on in the years 1955–69 at St. Mark's Hospital, London, are presented. The overall mortality of the primary surgery was 8·1 per cent, being 9·3 per cent in the years 1955–9, 10–6 per cent in the years 1960–4, and 5·3 per cent the years 1965–9. This mortality was 1·6 per cent in 128 patients treated electively, 10·7 per cent in 75 cases coming to urgent surgery, and 23·3 per cent in 75 cases coming to urgent surgery, and 23·3 per cent in 43 patients undergoing emergency operations. The mortality in this third group fell from 36·4 per cent in the years 1955–9 to 25 per cent in the years 1960–9. The indcidence of major postoperative complications for patients treated by total proctolectomy or colectomy and ileostomy was also clearly related to the preoperative servertity of the disease, being 18·8 per cent in the elective cases, 31·3 per cent in the urgent cases, and 40 per cent in the emergency cases. Late complications of surgery were, with the exception of intestinal obstruction requiring surgery, infrequent in this series and showed a marked fall in the last 5 years of the study. With the possible exception of urolithiasis, the investigation revealed no increased susceptibility to diseases or conditions of a general nature in the long-term study of these patients (average length of follow-up 7 years) and emphasized the excellent life expectancy in patients in whom radical surgery had been carried out in the absence of malignant change.