TOTAL COLECTOMY AND ILEORECTAL ANASTOMOSIS IN ULCERATIVE-COLITIS

In an attempt to determine the best indications for the classically ad opted ileo-rectal anastomosis (IRA) and the new techniques of restorat ive proctocolectomy, namely, ileal J-pouch-anal anastomosis (IAA) and ileal J-pouch-anal canal anastomosis (IACA), we retrospectively studie d 72 surgically treated patients with ulcerative colitis (UC) followed in our surgical department in the period between 1963 and 1994. Compa red to these new techniques, IRA had a lower incidence of postoperativ e fecal incontinence, and was one-stepped in the majority of the patie nts. No significant difference regarding postoperative bowel function, operation time, volume of bleeding, hospital stay, and the need for p ostoperative prednisolone was observed. We concluded that IRA is a goo d procedure that is indicated for patients receiving high-dose prednis olone, for those who need a quick return to social activity, and for t hose with poor anal function. IACA is a good indication for those pati ents with good anal function assessed preoperatively, who agree to rec eive a multi-step operation. For those patients with cancer or dysplas ia, IAA should be the operation of first choice.