Proctocolectomy with ileal reservoir and anal anastomosis

TLDR

The authors developed a proctocolectomy technique that avoids a permanent ileostomy for patients with ulcerative colitis or polyposis coli. The procedure involves excising all diseased bowel, constructing a terminal ileum reservoir, and performing an ileo‑anal anastomosis, and was applied to 21 patients with a mean follow‑up of 13.5 months. The operation had no mortality, early complications in 9 patients, and resulted in complete daytime continence, normal diet tolerance, and only two patients requiring medication, making it a satisfactory alternative to ileostomy.

Abstract

Summary A technique of proctocolectomy avoiding an ileostomy has been developed for patients with ulcerative colitis or polyposis coli. After excision of all diseased tissue a reservoir of terminal ileum is constructed which is brought through the rectal stump denuded of mucosa; an ileo-anal anastomosis is then carried out. Twenty-one patients (17 ulcerative colitis, 4 polyposis) have been treated and 20 followed for from 2 to 34 months (mean 13·5 months). There was no mortality but early complications occurred in 9 patients. All are currently well, with no disturbance of urinary or sexual function. Continence of faeces is complete in all during the day, but 1 patient evacuates unconsciously at night. The average frequency of evacuation is 3·8 times in 24 h. Ten patients void spontaneously. All patients tolerate a full diet and only 2 use medicaments to reduce frequency. This operation appears to be a satisfactory alternative to proctocolectomy with a permanent ileostomy.