Anal sphincter-saving operations for chronic ulcerative colitis

• Published in: The American journal of surgery Vol. 163; no. 1; pp. 5 - 11
• Main Author: Kelly, Keith A.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.01.1992; Elsevier; Elsevier Limited
• Subjects: Adult; Anal Canal; Anastomosis; Biological and medical sciences; Canals (anatomy); Colitis, Ulcerative - epidemiology; Colitis, Ulcerative - physiopathology; Colitis, Ulcerative - surgery; Defecation; Feces; Female; Humans; Ileostomy; Inflammatory bowel disease; Male; Medical sciences; Metronidazole; Ostomy; Patients; Postoperative Complications - epidemiology; Proctocolectomy, Restorative - methods; Quality of life; Rectum; Rectum - surgery; Signs and symptoms; Sphincter; Stomach, duodenum, intestine, rectum, anus; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Ulcerative colitis; Human; Ileum; Autotransplantation; Plasty; Chronic; Treatment; Anus; Surgery; Rectum; Digestive diseases; Intestinal disease; Colon; Technique; Ulcerative colitis
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/0002-9610(92)90244-L

Three anal sphincter-saving operations—ileorectostomy, ileal pouch-anal anastomosis, and ileal pouch-distal rectal anastomosis—are currently being used in the surgical treatment of chronic ulcerative colitis. All three operations remove the disease, or most of it, and yet they maintain transanal defecation, reasonable fecal continence, and a satisfactory quality of life. All three avoid permanent abdominal ileostomy. Ileorectostomy is the easiest to perform, but it leaves residual disease in the remaining rectum and proximal anal canal that may cause symptoms and that may predispose the patient to cancer. In contrast, ileal pouch-anal anastomosis, although a more technically demanding procedure, totally eradicates the colitis. Its main drawbacks—frequent stooling, nocturnal fecal spotting, and pouchitis—are usually satisfactorily treated with loperamide hydrochloride and metronidazole. Heal pouch-distal rectal anastomosis is somewhat easier to perform than ileal pouch-anal anastomosis and may result in less nocturnal fecal spotting. Like ileorectostomy, however, the operation leaves residual disease in the distal rectum and proximal anal canal. Considering all of these factors, the ileal pouch-anal operation is preferred today for most patients who require surgery for chronic ulcerative colitis.