Endorectal lleoanal Anastomosis with Isoperistaltic Heal Reservoir after Colectomy and Mucosal Proctectomy

Abstract

Patients (41) with chronic ulcerative colitis refractory to medical therapy and 4 with multiple polyposis have undergone total colectomy, mucosal protectomy and endorectal ileal pullthrough with ileoanal anastomosis at the UCLA Meidcal Center, USA, during the past 12 yr (mean age, 19.4 yr). Patients (38) underwent 2nd-stage closure of the ileostomy with construction of a side-to-side isoperistaltic ileal reservoir (mean, 6 mo.) after the ileal pullthrough operation. The anastomosis extended over a 20-30 cm distance and the lower end was placed within 6-8 cm of the ileoanal anastomosis. Transient reservoir inflammation, which occurred in half of the patients, was reduced by the use of oral metronidazole and was rarely found 6 mo. after operation. No patients died during the early or late postoperative periods. Cuff abscess in 2 patients and obstruction of the ileal reservoir outlet have required takedown of the reservoir (2 patients) or temporary ileostomy (3 patients). Of the 38 patients who have undergone lateral ileal reservoir construction, 33 have achieved a good to excellent result with complete continence and an average of 5 stools/24 h after 6 mo. At least 12 patients now participate in competitive athletics, normal sexual activity has been achieved in all but 1 patient. Seven patients await construction of the reservoir. Although a technically difficult operation, the long-term results (mean, 19.4 mo.) indicate that the pullthrough operation is a good alternative to standard proctocolectomy.