Total colectomy and ileorectal anastomosis for ulcerative colitis.

Abstract

AbstractThe 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.