PULL-THROUGH PROCEDURES PERFORMED MONTHS TO YEARS AFTER PERMANENT PROCTECTOMY

PURPOSE: Patients who have undergone proctectomy without concomitant r ectal reconstruction or Coloanal anastomosis were not normally conside red candidates for re-establishment of anal continuity until a case re port published in 1985. With the addition of nine patients, reported h erein is a series of ten patients who have undergone delayed pull-thro ugh procedures months to years after permanent proctectomy. PATIENTS: ren patients (including the single case reported in 1985) have undergo ne delayed pull-through procedures up to 24 years after permanent proc tectomy and ostomy formation. Delayed ileal pouch-anal anastomoses wer e performed in nine patients, and delayed coloanal anastomosis was per formed in one patient. There were four males and six females, each of whom had evidence of external sphincter contraction on physical examin ation. Average age was 33 (range, 24-51) years at the time of reconstr uction. Average duration of follow-up is 32 (range, 1-96) months. RESU LTS: One patient is awaiting ileostomy closure, Five bf: nine patients use constipating agents. Two patients are constipated and use enemas to aid in evacuation. None are wearing protective undergarments, One p atient had his ileostomy reconstructed eight years after delayed pull- through for uncontrollable diarrhea associated with chemotherapy for m ultiple myeloma and recently died. Postoperative complications include d wound infection (3), enterocutaneous anastomotic stricture requiring anoplasty (2), small bowel obstruction (1), pneumonia SIGNS: Delayed pull-through procedures performed months to years after permanent proc tectomy Call be performed in selected patients, with results comparabl e to rectal reconstruction done at the time of proctectomy.