title: A reappraisal of the ileo-rectal anastomosis in ulcerative colitis.
abstract: Colectomy is still frequently required in the care of ulcerative colitis. The most common indications are either non-responding colitis in the emergency setting, chronic active disease, steroid-dependent disease or neoplastic change like dysplasia or cancer. The use of the ileal pouch anal anastomosis has internationally been the gold standard, substituting the rectum with a pouch. Recently the use of the ileorectal anastomosis has increased in frequency as reconstructive method after subtotal colectomy. Data from centres using ileorectal anastomosis have shown the method to be safe, with functionality and risk of failure comparable to the ileal pouch anal anastomosis. The methods have different advantages as well as disadvantages, depending on a number of patient factors and where in life the patient is at time of reconstruction. The ileorectal anastomosis could, together with the Kock continent ileostomy, in selected cases be a complement to the ileal pouch anal anastomosis in ulcerative colitis and should be discussed with the patient before deciding on reconstructive method.
authors: Department of Surgery, County Council of Östergötland, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden par.myrelid@liu.se.
authors: Pär
authors: P
authors: Myrelid
authors: Faculty of Medicine, University of Oslo, and Department of GI Surgery, Akershus University Hospital, Oslo, Norway.
authors: Tom
authors: T
authors: Øresland
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects; D003672:Defecation / Q000502:physiology; D005298:Fertility; D006801:Humans; D007082:Ileum / Q000601:surgery*; D011159:Population Surveillance; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000209:etiology*; D012007:Rectum / Q000601:surgery*; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D017211:Treatment Failure
keywords: Subtotal colectomy; ileal pouch anal anastomosis; ileorectal anastomosis; reconstruction; surgery; ulcerative colitis