title: A new operative technique for restorative proctocolectomy: the endorectal pull-through combined with a double-stapled ileo-anal anastomosis.
abstract: BACKGROUND
  In children, restorative proctocolectomy is usually accomplished by a rectal mucosectomy followed by a hand-sewn ileo-anal anastomosis+/-ileal pouch. In certain patients, a hand-sewn anastomosis can be technically difficult. This led us to develop a new technique that combines endorectal mucosectomy with a double-stapled ileo-anal anastomosis.
  
  
  METHODS
  After colectomy, an ileal J-pouch is constructed. The head of the circular stapler is placed in the apex of the pouch and secured. An endorectal mucosectomy is completed from the abdomen to approximately 1.5 cm above the dentate line. The rectal mucosal/submucosal tube is everted onto the perineum. A transverse stapler is positioned 1.5 cm above the dentate line on the perineum and fired. The circular stapler is inserted transanally and the trocar advanced through the transverse staple line until the head and anvil are mated and then fired. A loop ileostomy is constructed.
  
  
  RESULTS
  Thirteen patients, with a mean age of 12.3 years, have undergone endorectal mucosectomy with a double-stapled anastomosis without major complication. The operative time averaged 280+/-70 minutes. The mean 24-hour stool frequency, with 9 months' follow-up, was 6.8+/-3.2, of which 1+/-0.7 were at night.
  
  
  CONCLUSIONS
  The combination of endorectal mucosectomy with a double-stapled anastomosis is a new approach for patients requiring restorative proctocolectomy. In our early experience, this technique was completed with a low complication rate and excellent functional results.
authors.affiliation: Department of Surgery, C S Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, Michigan 48109-0245, USA.
authors.forename: James D
authors.initials: JD
authors.lastname: Geiger
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Teitelbaum
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Hirschl
authors.forename: Arnold G
authors.initials: AG
authors.lastname: Coran
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D016737:Proctocolectomy, Restorative / Q000379:methods*