J.Jpn. Surg. Soc.. 93(9): 1083-1086, 1992

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Report on the annual meeting

CONTROVERSY
－SURIGCAL VS. MEDICAL MANAGEMENT FOR INFLAMMATORY BOWEL DISEASE－

The controversy in the treatment of inflammatory bowel disease is how to decide surgical vs. medical management in each case. Of 309 patients with ulcerative colitis in our department, 63 (20%) patients had received surgical treatment. The mean age was 33.5±13.7 years old and the mean duration from onset to operation was 6.72±5.51 years. The indications for surgical treatment were 47 (75%) resistant cases against medical treatment, 9 (14%) severe cases and 7 (11%) cancer or dysplasia cases. In surgical cases compared with medical ones, the ratio of total duration (months)/number of admission showed below 10, and the total amount of used steroid was over 300mg per month. These ratios were considered to be the useful markers for surgical indication. Operative procedures were 15 total proctocolectomy+ileostomy, 29 total colectomy+ileorectal anastomosis, 13 total proctocolectomy+ileoanal anastomosis and 6 others. Restrorative proctocolectomy using double stapling method with two stage operation was chosen in 8 patients because of easier and safer operative procedure and a few complications. We conclude that early surgical treatment for the patients resistant against medical management is considered to improve the patients' quality of life.

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