Endorectal lleal Pullthrough with Isopehstaltic lleal Reservoir for Colitis and Polyposis

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Abstract
Seventy-eight patients with ulcerative colitis refractory to medical therapy and 8 with colonic polyposis have undergone total colectomy, mucosal protectomy, endorectal ileal pullthrough with ileoanal anastomosis and diverting ileostomy at the UCLA Medical Center [USA] during the past 7 yr. Seventy-seven patients underwent a 2nd stage operation with construction of a lateral isoperistatic ileal reservoir, 12-30 cm long and closure of the ileostomy. A reservoir 10-15 cm long appears optimal for children and 20 cm long appears to function best for adults. Major complications were either related to obstruction of the reservoir outlet from leaving a rectal muscle cuff longer than 6 cm and/or constructing the reservoir too long in the early experience (16 patients), or from cuff abscesses (4 patients). Out of the 77 patients, these problems led to reservoir removal in 3, temporary ileostomy in 8 and reservoir revision in 16. Persistent cuff abscess was the cause for reservoir removal in 2 of 4 patients. Continence was achieved in all patients within 2 wk. Good to excellent results were obtained in all patients within 2 wk. Good to excellent results were obtained in 65 patients. At 1 yr, 78% were completely continent during the day, 18% had minor seepage and 4% had occasional soiling. Frequency of defecation in patients without complications, or those surgically corrected, was 7 per 24 h within 3 mo. There was no deaths. Six patients were found to have unsuspected cancer at operation. No patient experienced bladder dysfunction or abnormal sexual function. Although a technically difficult operation, the long-term results indicate that the pullthrough operation is a good alternative to protocolectomy with ileostomy.