Abdominopreanal proctocolectomy and ileal U-pouch in ulcerative colitis or familial adenomatous polyposis.
In some cases of ulcerative colitis and familial adenomatous polyposis, cancerous changes frequently occur on the distal rectum, in which case a restorative proctocolectomy is not recommended because of the limitations of a radical resection. Even if rectal cancer is not confirmed preoperatively, a strong possibility of cancer in the rectum could afford some support for a radical pelvic dissection during the anus-sparing procedure. The author designed a new operative procedure for resolving this problem. It is an abdominopreanal extrasphincteric proctocolectomy with preileal-pouch positioning of the distal ileal segment including the ileocecal sphincter (ileal U-pouch) for the treatment of ulcerative colitis and familial adenomatous polyposis coli (restorative radical proctocolectomy). The author performed this restorative radical proctocolectomy on seven patients over the past 5 years at the Department of Surgery, Pusan National University Hospital, of which four cases were ulcerative colitis and three were familial adenomatous polyposis. The results obtained were as follows: (a) The most common sequela was nocturnal seepage, which lasted for 6 months in 4 patients after the final operation. (b) The mean frequency of defecation was six times per day at 6 months after the final operation. (c) The average amount of stool was about 460g per day at 6 months after the final operation. Therefore, the ileal U-pouch is considered to be effective in reducing the daily amount of stool. A preanal extrasphincteric approach could be especially useful in the case of a difficult dissection of the anterectal space while also providing an effective dependent drainage of the ileoanal anastomotic space.
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N G
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Department of Surgery, Pusan National University Hospital, Korea.
D011125:Adenomatous Polyposis Coli / Q000235:genetics / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D003093:Colitis, Ulcerative / Q000503:physiopathology / Q000601:surgery*; D003672:Defecation; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000379:methods*