Surgery in Ulcerative Colitis - Return of the Ileorectal Anastomosis

Abstract

The main advantages of ileorectal anastomosis for patients with ulcerative colitis are that it is easier to perform and the complication rate is probably lower than for the pelvic pouch procedure. Ileoreccal anastomosis is, however, not suitable for all patients. Patients with severely inflamed and scarred rectums with low compliance are not suitable candidates for the procedure. With the use of the new steroids, however, the number of patients suitable for ileorectal anastomosis will probably increase. The functional outcome, particularly in terms of continence, is probably better following ileorectal anastomosis than after pelvic pouch. The need for long term cancer surveillance is a problem, but newer methods for surveillance may increase further the possibilities of controlling cancer risk in the future. There seems to be an equal need for future medical surveillance following both surgical procedures. In balance, newer methods of medical therapy and cancer surveillance will probably lead to a return to ileorectal anastomosis in a significant number of patients.