Coull, DB; (1995) A study of changes in histology, sexual function, haematological and nutritional status following restorative proctocolectomy. Doctoral thesis , UCL (University College London).

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Abstract

Restorative proctocolectomy (RP) has become the gold-standard surgical procedure for Ulcerative Colitis (UC) and Familial Adenomatous Polyposis (FAP). Following proctoclectomy a l-2cm "cuff of columnar rectal epithelium is retained that has unknown risk of malignant change. Markers of malignant potential in UC include aberrant p53 expression and dysplasia. We undertook a prospective study comprising serial surveillance biopsy and assessed the occurrence of aberrant p53 expression, epithelial dysplasia and carcinoma in the retained anorectal cuff following RP. RP is often performed on young adults within the peak parenting age bracket. Pelvic dissection may result in damage to the autonomic nerves of sexual function and consequently affect fertility in male and female patients. We examined the impact of ileo-anal pouch formation on male and female sexual and reproductive function. RP involves terminal ileal resection and formation of a small bowel reservoir that encourages bacterial overgrowth These factors may predispose to nutritional deficiencies, especially low vitamin B12 levels. We examined short and long-term haematological and nutritional status following RP. No dysplasia was found within cuff-surveillance biopsies up to 12 years post-RP, suggesting that cuff surveillance in the first decade after pouch formation is unnecessary, but should continue for patients with high grade dysplasia or carcinoma in the original colectomy specimen. p53 expression was not useful in pre-dysplastic surveillance of cuff biopsies from patients who have undergone RP for UC One quarter of our patients developed a subnormal vitamin B12 levels following RP. The cause of this is uncertain. Serum B12 levels should be measured during follow up and those with subnormal B12 levels, should see them successfully restored to a normal value after treatment with oral B12 replacement therapy. On both short and long term follow-up, the majority of patients maintained a normal micronutrient profile. Pregnancy rates decreased following RP and this was associated with a high incidence of male and female sexual dysfunction.

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