Mucosal proctectomy and ileoanal pull-through technique and functional results in 23 consecutive patients.
Mucosal proctectomy with ileoanal pull-through in the treatment of ulcerative colitis and familial polyposis provides a technique for the preservation of the anal sphincters and relatively normal mechanisms of continence. Five patients had straight ileoanal anastomosis while 18 had the construction of a J-pouch. A two-team approach was used for simultaneous abdominal and perineal procedures to facilitate a shortened operating time. A loop ileostomy was routinely used in the postoperative period and was closed an average of 4.5 months (range: 2-16 months) later without complication. Prolonged preoperative hospitalization was rarely necessary and outpatient steroid enema preparation was routinely used. There were no deaths. Nineteen patients with functioning pull-through procedures have been followed an average of 23 months (range: 3-42 months). Two other patients have not had ileostomy closure because of complications. The two remaining patients had intractable diarrhea and have since undergone conversion to a permanent ileostomy. The 19 patients are continent, having three to nine bowel movements each day. Nearly all wear a perineal sanitary pad because of rare, unpredictable leakage of small amounts of fluid, especially at night. Complications were significant in this group of patients. Intestinal obstruction was a frequent problem, occurring in 52 per cent of the entire series and necessitating reoperation in 22 per cent. Anal stricture was a problem in another five patients. A variety of other minor problems occurred and most were treated nonoperatively. In spite of moderate diarrhea and occasional leakage of stool, all patients with functioning pull-through procedures prefer their current status to life with an ileostomy.(ABSTRACT TRUNCATED AT 250 WORDS)
D011125:Adenomatous Polyposis Coli / Q000601:surgery; D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D002648:Child; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000601:surgery; D003967:Diarrhea / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D007082:Ileum / Q000601:surgery*; D007413:Intestinal Mucosa / Q000601:surgery; D007415:Intestinal Obstruction / Q000209:etiology; D008297:Male; D008722:Methods; D008875:Middle Aged; D011183:Postoperative Complications; D012006:Rectovaginal Fistula / Q000209:etiology; D012007:Rectum / Q000601:surgery*; D012086:Reoperation