Endorectal lleal Pullthrough with La teral lleal Reservoir for Benign Colorectal Disease

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Abstract
Eight patients with ulcerative colitis and 1 with multiple polyposis have undergone total colectomy, mucosal proctectomy, endorectal ileal pullthrough with ileoanal anastomosis, and a diverting ileostomy during a 2 yr period. Five of the patients underwent construction of side-to-side ileal reservoirs and closure of the cutaneous ileostomies within 6 mo. Wound complications were uncommon compared with the previous clinical experience with an S-shaped ileal reservoir. Each of the 5 patients has complete fecal continence with an average of 4 bowel movements/24 h period. A temporary diverting ileostomy and transcutaneous reservoir catheter for irrigation help to minimize complications. Construction of an ileal reservoir proximal to the endorectal ileal pullthrough segment provides a better opportunity for fecal storage than if no reservoir is used because it reduces defecatory urgency and frequency as well as perineal inflammation. The lateral ileal reservoir produces less stasis and achieves a more regular defecatory pattern than the S-shaped reservoir. Favorable clinical experience with the lateral internal ileal reservoir, and ileoanal anastomosis in 5 patients who had ulcerative colitis or multiple polyposis suggest that further clinical application in selected patients is warranted.