This operation began to be used in the early 1 950s as a means of avoiding a
permanent ileostomy. At first it was not generally accepted because it did not
remove all the disease since the rectum was left behind. However it is now felt
that the operation does have a place in particular cases.
Indications
Only a minority of patients with ulcerative colitis are suitable for this procedure.
They should have a rectum which the surgeon thinks will function adequately as
a reservoir after the operation. It should therefore not be too inflamed and
narrowed down by the effects of the disease. The anal sphincter must be
adequately strong and there should be no suggestion of impending or actual
cancer.
Technique
The procedure involves removal of the colon through an abdominal incision with
the immediate joining (anastomosis) of the last part of the small bowel (ileum) to
the rectum with stitches. No surgery on the anal area is carried out.
Hospital stay is about 6-8 days and convalescence is usually about two months.
As with any bowel operation, adhesion obstruction is a possible complication and
rarely a leak from the anastomosis occurs. This latter
complication is serious and usually requires another operation, often including a
temporary ileostomy.
Results
Although every effort is made in selecting patients there is almost always some
degree of inflammation still present in the rectum. Even after recovery from the
operation this can flare up causing diarrhoea with urgency. There is still also the
risk of cancer developing in the rectal stump, although it is rare. However,
because of this regular follow-up checks are obligatory. This will involve
examination of the rectum by a sigmoidoscope, taking a biopsy at the same time
for the pathologist to look at.
Followed over several years, persisting rectal inflammation leads to failure owing
to uncontrollable diarrhoea in about 25% of cases. A few more cases fail
because of the development of impending cancer. Thus about two thirds of
patients are well served by the operation. Failure means the need for a further
operation. This could be either removal of the rectum with a permanent ileostomy
or a ‘pouch procedure’. Colectomy with ileo-rectal anastomosis is therefore a
compromise operation. The surgeon accepts that some disease remains in
exchange for avoiding a permanent ileostomy.
permanent ileostomy. At first it was not generally accepted because it did not
remove all the disease since the rectum was left behind. However it is now felt
that the operation does have a place in particular cases.
Indications
Only a minority of patients with ulcerative colitis are suitable for this procedure.
They should have a rectum which the surgeon thinks will function adequately as
a reservoir after the operation. It should therefore not be too inflamed and
narrowed down by the effects of the disease. The anal sphincter must be
adequately strong and there should be no suggestion of impending or actual
cancer.
Technique
The procedure involves removal of the colon through an abdominal incision with
the immediate joining (anastomosis) of the last part of the small bowel (ileum) to
the rectum with stitches. No surgery on the anal area is carried out.
Hospital stay is about 6-8 days and convalescence is usually about two months.
As with any bowel operation, adhesion obstruction is a possible complication and
rarely a leak from the anastomosis occurs. This latter
complication is serious and usually requires another operation, often including a
temporary ileostomy.
 |
Although every effort is made in selecting patients there is almost always some
degree of inflammation still present in the rectum. Even after recovery from the
operation this can flare up causing diarrhoea with urgency. There is still also the
risk of cancer developing in the rectal stump, although it is rare. However,
because of this regular follow-up checks are obligatory. This will involve
examination of the rectum by a sigmoidoscope, taking a biopsy at the same time
for the pathologist to look at.
Followed over several years, persisting rectal inflammation leads to failure owing
to uncontrollable diarrhoea in about 25% of cases. A few more cases fail
because of the development of impending cancer. Thus about two thirds of
patients are well served by the operation. Failure means the need for a further
operation. This could be either removal of the rectum with a permanent ileostomy
or a ‘pouch procedure’. Colectomy with ileo-rectal anastomosis is therefore a
compromise operation. The surgeon accepts that some disease remains in
exchange for avoiding a permanent ileostomy.
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