An improved technic of colectomy for ulcerative colitis and disseminated adenomatosis

Summary

Details of an improved technic of a one-stage ileocoloproctectomy with establishment of an ileostomy are described. The salient features are:

• 1. A hockey-stick type of incision is used in the abdominal wall to facilitate exposure.

• 2. The blood supply of the entire colon is preserved until all of the large bowel has been mobilized. By this provision, except when malignancy is suspected, the abdomen can be closed at any time should the condition of the patient call for immediate termination of the operation.

• 3. The inferior mesenteric artery is ligated at its aortic origin to avoid unnecessary clamping of its branches.

• 4. The internal iliac artery is ligated to reduce bleeding during the perineal phase of the operation.

• 5. Dissection is carried out close to the wall of the rectum to avoid impotence especially in the young patient.

• 6. Meticulous care is exercised in constructing the ileostomy to prevent subsequent complications.

This procedure was employed in 86 patients with ulcerative colitis and disseminated adenomatosis with a mortality rate of 1.1 per cent.