Ileorectal Anastomosis for Ulcerative Colitis

Abstract

This operation is a well-established but not widely used operation. One might say that its timing has been “bad” in arriving on the surgical scene. The procedure was held in some disrepute throughout the past 30 years because of prevailing notions that the failure rate (leakage from the anastomosis, need for later proctectomy) was high and that rectal cancer was likely to occur. A large number of reports, in the 1970s and 1980s did much to dispel these pessimistic attitudes, but no sooner had the operation come of age or at least become respectable when applied to a specific patient, than there emerged the operation of ileoanal anastomosis with pelvic reservoir. Since this latter operation is promoted as resolving two of the major concerns about ileorectal anastomosis — namely, need for future proctectomy because of proctitis (and diarrhea) and cancer/cancer prophylaxis, it behooves the protagonist of ileorectal anastomosis to not only discuss these various sequelae and risks of the operation, but to do so in relationship to like sequelae of the pelvic reservoir.