FACTORS FAVORING CONTINENCE, THE AVOIDANCE OF A DIVERTING ILEOSTOMY AND SMALL-INTESTINAL CONSERVATION IN THE ILEOANAL POUCH OPERATION

Ileoanal pouch operation was performed upon 38 consecutive patients wi th ulcerative colitis (36 patients) or familial polyposis (two patient s). Mucosectomy was avoided by rectal mobilization to the dentate line and eversion and stapling of the exteriorized anorectal junction with the dentate fine in view. An 8 centimeter J pouch was stapled to the anorectal junction. A diverting ileostomy was not used in 34 of the 38 patients. Physicians independent of the operation evaluated patients postoperatively. Eighty-four percent of the patients did not experienc e any problems with incontinence or nocturnal spotting at one month po stoperatively. No incontinence or nocturnal spotting was seen in any p atient by one year postoperatively, with the exception of one patient with chronic pouchitis who had occasional nocturnal spotting that cont inues to improve. The average number of bowel movements per 24 hours w as five at 12 months postoperatively, despite the small pouch. The mea n distance from the dentate line to the ileoanal anastomosis was 0.9 /- 0.5 centimeter (range of zero to 2 centimeters).