Ulcerative colitis and polyposis coli. Surgical options.
Until a medical cure for ulcerative colitis is available, it is up to the surgeon to provide a solution. With the wealth of experience now available, the operation of ileal pouch with anal anastomosis must be considered as an option in treating the young or well-motivated patient. Screening of families in whom polyposis coli has been found can prevent colon cancer developing. For this group of patients, who may be totally asymptomatic, to be able to offer a reconstructive operation may make it easier for such patients to accept colectomy. The value of consultation between medical and surgical gastroenterologists in order to time surgery is vital, and an exact histologic diagnosis in inflammatory bowel disease may prevent the potential disaster of constructing an ileal pouch in a patient with Crohn's disease. The construction of a pouch is not difficult, being made up of several familiar surgical steps in an unfamiliar setting. However, it is a long operation, frequently taking more than 4 hours, and mucosal protectomy can be rather awkward. For these reasons and the problems with patient counseling, we believe ileal pouch with anal anastomosis operations should be performed at referral centers. We still have to decide on the best type of pouch to use, but it is encouraging that better antibiotics, safer anesthesia, and new techniques such as the intraluminal bypass tube and rectal sleeve dissection have helped to make this operation more successful for a greater number of patients.
Sackier
J M
JM
Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London, England.
Wood
C B
CB
D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D003082:Colectomy / Q000379:methods; D003093:Colitis, Ulcerative / Q000601:surgery*; D003111:Colonic Polyps / Q000601:surgery*; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects / Q000379:methods