Ileorectal Anastomosis in Ulcerative Colitis

Grüner, O. P. N.; Flatmark, A; Naas, R; Fretheim, B; Gjone, E

doi:10.1080/00365521.1975.12097024

Cited by 47 publications

(5 citation statements)

References 12 publications

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“…Attention to technical detail, and preservation of the enure rectum are as ~mportant as case selection if the problem of postoperative bowel frequency [5,6] is to be controlled.…”

Section: Discussionmentioning

confidence: 99%

“…The smaller the rectal capacity, the less effective reservoir function becomes. It is, therefore, necessary to keep the entire rectum if an ileorectal hook-up is hot to be followed by an unacceptable frequency of defecation [5,6]. There is no difficulty in justifying this if the rectum is minimally or moderately inflamed, but sometimes as a result of chronic inflammation, the rectum becomes narrowed and rigid and may have strictured areas.…”

Section: Functional Problemsmentioning

confidence: 99%

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Total colectomy and ileorectal anastomosis for ulcerative colitis

Mann

1988

World j. surg.

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The pros and cons of total colectomy and ileorectal anastomosis for ulcerative colitis are discussed based on the author's experience and on the collective results with this operation at St. Mark's Hospital, London, over a 20‐year period. Its chief merits are that it is easy to perform, carries a low operative mortality and morbidity, and, when it works well, usually affords excellent anorectal function. It has 2 main disadvantages: in a proportion of cases it proves unable to control the disease because of continuous or recurrent activity of the residual proctitis, and occasionally a carcinoma may develop in the rectal stump. But patients who have failed with it can easily be salvaged, as a rule, by proceeding to a proctectomy and ileoanal anastomosis (or ileostomy). As for the risk of cancer arising in the rectum, fortunately, this can now be largely contained by regular follow‐up attendances, at which rectal biopsies are taken to look for evidence of the premalignant change of severe epithelial dysplasia, a precaution that is absolutely essential after this operation. Important points in the technique of ileorectal anastomosis are emphasized, and the suitability of the operation for colitis in various clinical settings is examined.

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“…Attention to technical detail, and preservation of the enure rectum are as ~mportant as case selection if the problem of postoperative bowel frequency [5,6] is to be controlled.…”

Section: Discussionmentioning

confidence: 99%

Section: Functional Problemsmentioning

confidence: 99%

Total colectomy and ileorectal anastomosis for ulcerative colitis

Mann

1988

World j. surg.

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“…By refraining from primary proctectomy, there remains a possibility for the secondary, elective construction of an ileorectal anastomosis, as advocated by Aylett [26]. Since secondary proctectomy proved necessary in 25-90% of cases in other reports [14,25,26,28], and discouraging results of secondaryileorectal anastomosis have been reported [26,28], we have made secondary proctectomy a part of our routine treatment. However, recent studies of elective cases of ulcerative colitis successfully treated by abdominal colectomy and ileorectal anastomosis [24,29] indicate that a routine policy of total proctocolectomy may be questioned again.…”

Section: Discussionmentioning

confidence: 99%

“…Onestage proctocolectomy was used by Goligher [2] in fulminating cases. Abdominal colectomy and primary ileorectal anastomosis carry a higher risk and have not been recommended as an urgent operation in severe ulcerative colitis [2,24,25]. After 3 cases early in this series, we have performed no more such operations.…”

Section: Discussionmentioning

confidence: 99%

Urgent surgery for ulcerative colitis: Early colectomy in 132 patients

et al. 1981

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In accordance with a policy of early colectomy for severe ulcerative colitis, urgent/emergency surgery was performed in 132 patients during the last decade. The indication for surgery was toxic megacolon (45 cases), massive hemorrhage (6 cases), and fulminating colitis not responding to medical treatment within 4 days (81 cases). The operations performed were proctocolectomy (9 cases, mostly of hemorrhage), colectomy plus ileorectal anastomosis (3 cases), and abdominal colectomy plus ileostomy plus proctostomy (CIP) (120 cases, including 45 of toxic megacolon). Secondary proctectomy (SP) was later performed in 113 CIP cases. A major distinction of this series is a colonic perforation rate of only 3% (9% in toxic megacolon). Mortality after urgent/emergency colectomy was 5.3%. Total mortality within 2 years (including SP) was 6.8%. Two of 4 patients with colonic perforation died, as did 1 patient with colonic cancer. Postoperative complications occurred in 40% of the patients after urgent/emergency colectomy, and in 52% after all surgery combined (including SP). Mortality and morbidity were higher in toxic megacolon and in patients older than 60 years. Late complications, mostly persisting perineal sinuses, were seen in 31%. We believe that the low colonic perforation rate, and the subsequent favorable mortality and morbidity, are the results of our policy of early colectomy. Also, this study lends support to the choice of abdominal colectomy plus ileostomy plus proctostomy (and subsequent secondary elective proctectomy) when urgent/emergency surgery is indicated for severe ulcerative colitis.

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“…The disadvantages are that the rectal inflammation usually persists and may become worse, with severe symptoms and the risk of local and remote complications of ulcerative colitis, such as abscesses, fistulas, strictures, arthritis, uveitis, and skin lesions. As a result, quite a large proportion of the patients needs to have the rectum removed, the proportion in different series varying from 6% to 40% [29][30][31]. Even if the rectum does not give rise to these problems, there is a significant risk of cancer arising in it; for example, Aylett [27] recorded 12 cases in his 461 patients (2.6%) with ileorectal anastomosis.…”

Section: The Choice Of Operation For Chronic Diseasementioning

confidence: 99%

Proctocolectomy for ulcerative colitis

Lee

Truelove

1980

World j. surg.

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The majority of patients with ulcerative colitis can be managed satisfactorily throughout their lives by medical treatment, but a minority require colectomy. In severe attacks, emergency surgery is often required to save the patient's life. In chronic disease not responding well to medical treatment, elective colectomy will restore the patient to good health. Colectomy is also necessary for certain local complications, such as cancer, severe fistulas, and strictures. Prophylactic colectomy is indicated in patients with long-standing disease in whom there are factors associated with a high risk of developing cancer of the large bowel. For all these indications, it is our opinion that single-stage proctocolectomy is the operation of choice in the great majority of patients. Finally, we consider that the best results are obtained when the physician and the surgeon work together in the closest possible cooperation.

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Ileorectal Anastomosis in Ulcerative Colitis

Cited by 47 publications

References 12 publications

Total colectomy and ileorectal anastomosis for ulcerative colitis

Total colectomy and ileorectal anastomosis for ulcerative colitis

Urgent surgery for ulcerative colitis: Early colectomy in 132 patients

Proctocolectomy for ulcerative colitis

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