Sphincter-Sparing Operations for Chronic Ulcerative Colitis

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Abstract
Traditionally, proctocolectomy and Brooke ileostomy has been offered to patients with chronic ulcerative colitis requiring an operation for therapeutic or prophylactic indications. The functional results of this approach were good but the patients were incontinent. Our hypothesis has been that by facilitating control of enteric content, the quality of life after proctocolectomy would be enhanced. Ideally, an operation which provides such control should not only excise all diseased and potentially diseased bowel, but should preserve the anal continence mechanism. The aim of this report is to detail how a new sphincter-sparing operation, ileal pouch-anal anastomosis, may fulfill these ideal criteria, while the more traditional continence-preserving approach of ileorectal anastomosis may not. Finally, the current and future role of ileorectal anastomosis is assessed in light of the recent introduction of ileal pouch-anal anastomosis.

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