Objective: To evaluate the clinical differences between conventional and restorative proctocolectomy in the treatment of ulcerative colitis.

Methods: Retrospective analysis. Methods: University hospital, Finland. Methods: 240 consecutive patients with ulcerative colitis who underwent elective proctocolectomy between 1976 and 1990. Methods: Proctocolectomy and conventional ileostomy (n = 119) or restorative proctocolectomy (n = 121). Methods: Early and late surgical morbidity and recovery time.

Results: There were no postoperative deaths after restorative proctocolectomy and one patient (1%) died after conventional proctocolectomy. Two other patients (2%) with ileostomies died of late complications. Delayed perineal would healing after conventional ileostomy (n = 45, 38%) and either early (n = 31, 26%) or late (n = 19, 16%) defects of the ileoanal anastomosis after restorative proctocolectomy caused most problems. Reoperations (early or late) were needed in 45 (38%) and 44 (36%) patients after Brooke ileostomy and restorative proctocolectomy, respectively. Major complications, however, were more common and the duration of sick leave was a month longer in the pouch group.

Conclusions: Ulcerative colitis can safely be managed with either conventional or restorative proctocolectomy. In most cases the patient's preference should dictate the choice of procedure.