Abstract
A safe and practical procedure for total colectomy and mucosal proctectomy with ileonal anastomosis has been developed and performed by us on 11 patients with adenomatosis coli and two patients with ulcerative colitis. The major features of the operative procedure are 1) total removal of the rectal mucosa to just above the dentate line; 2) preservation of anorectal function by a long rectal cuff procedure achieved by rectal mucosal excision from a level just below the sacral promontory, using a rectal internal stent and gauze packing techniques for rectal mucosal stripping, with, in some patients, an ileal reservoir added; and 3) prevention of pelvic sepsis by intraoperative rectal irrigation, rectal cuff drainage, and a temporary defunctioning loop ileostomy. Of six patients with at least three months of follow-up after reconstruction, each has returned to normal life, averaging two to seven semiformed stools each day. A side-to-end ileoanal anastomosis with a lowlying, loop-type ileal reservoir provided the best functional results.
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Lockhart-Mummery HE, Dukes CE, Bussey HJ. The surgical treatment of familial polyposis of the colon. Br J Surg 1956;43:476–81.
Bussey HJ. Familial polyposis coli: family studies, histopathology, differential diagnosis, and results of treatment. Baltimore: Johns Hopkins University Press, 1975.
Moertel CG, Hill JR, Adson MA. Management of multiple polyposis of the large bowel. Cancer 1971;28:160–4.
Utsonomiya J, Iwama T. Studies of hereditary gastrointestinal polyposis. Asian Med J 1978;21:12–31.
Utsonomiya J, Iwama T. Familial large bowel cancer. In: DeCosse JJ, ed. Large Bowel Cancer, Clinical Surgery International. New York: Churchill Livingstone, 1981.
Aylett SO. Three hundred cases of diffuse ulcerative colitis treated by total colectomy and ileo-rectal anastomosis. Br Med J 1966;1:1001–5.
Binder SC, Miller HH, Deterling RA Jr: Fate of the retained rectum after subtotal colectomy for inflammatory disease of the colon. Am J Surg 1976;131:201–3.
Turnbull RB Jr, Hawk WA, Weakley FL. Surgical treatment of toxic megacolon: ileostomy and colostomy to prepare patients for colectomy. Am J Surg 1971;122:325–31.
Ottinger LW. Frequency of bowel movements after colectomy with ileorectal anastomosis. Arch Surg 1978;113:1048–9.
Nissen R. Berlin Chirurgical Society. Chirurg 1933;15:888–90.
Ravitch MM. Anal ileostomy with sphincter preservation in patients requiring total colectomy for benign conditions. Surgery 1948;24:170–87.
Ravitch MM, Sabiston DC Jr., Anal ileostomy with preservation of the sphincter: a proposed operation in patients requiring total colectomy for benign lesions. Surg Gynecol Obstet 1947;84:1095–9.
Goligher JC. The functional results after sphincter-saving resections of the rectum. Ann R Coll Surg Engl 1951;8:421–38.
Best RR. Evaluation of ileoproctostomy to avoid ileostomy in various colon lesions. JAMA 1952;150:637–42.
Devine J, Webb R. Resection of the rectal mucosa, colectomy, and anal ileostomy with normal continence. Surg Gynecol Obstet 1951;92:437–42.
Martin LW, LeCoultre C, Schubert WK. Total colectomy and mucosal proctectomy with preservation in ulcerative colitis. Ann Surg 1977;186:477–80.
Safaie-Shirazi S, Soper RT. Endorectal pull-through procedure in the surgical treatment of familial polyposis coli. J Pediatr Surg 1973;8:711–5.
Peck DA. Rectal mucosal replacement. Ann Surg 1979;191:294–303.
Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. Br Med J 1978;2:85–8.
Tosatti E. The ileo-anal-channel-stomy. Surg Italy 1973;3:201–5.
Goligher JC, Hughes ES. Sensibility of the rectum and colon: its role in the mechanism of anal continence. Lancet 1951;1:543–7.
Ferrari BT, Fonkalsrud EW. Endorectal ileal pullthrough operation with ileal reservoir after total colectomy. Am J Surg 1978;136:113–20.
Karlan M, McPherson RC, Watman RN. An experimental evaluation of fecal continence—sphincter and reservoir— in the dog. Surg Gynecol Obstet 1959;108:469–75.
Valiente MA, Bacon HE. Construction of pouch using “pantaloon” technique for pull-through of ileum following total colectomy: report of experimental work and results. Am J Surg 1955;90:742–50.
Peck DA, Hallenback GA. Fecal continence in the dog after replacement of rectal mucosa with ileal mucosa. Surg Gynecol Obstet 1964;119:1312–20.
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Utsunomiya, J., Iwama, T., Imajo, M. et al. Total colectomy, mucosal proctectomy, and ileoanal anastomosis. Dis Colon Rectum 23, 459–466 (1980). https://doi.org/10.1007/BF02987076
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DOI: https://doi.org/10.1007/BF02987076