Abstract
Ileal diversion is an important adjunct to restorative proctocolectomy but may produce increased morbidity and requires a second-stage closure. This study reports results utilizing a one-stage procedure designed to retain the benefits of proximal decompression without the liabilities of additional surgical procedures. Eight patients, three men (with ulcerative colitis) and five women (one with familial polyposis coli and four with ulcerative colitis), were selected for the single-stage restorative proctocolectomy with intraluminal decompression in lieu of diverting loop ileostomy. The abdominal proctocolectomy was performed to the level of the anorectal junction. In five patients, the rectum was closed using the TA 55™ (U.S. Surgical Corporation, Norwalk, CT), 4.8-mm stapler. AJ-pouch was constructed with multiple firings of the GIA 90™ (U.S. Surgical Corporation) stapler. These patients had continuity restored utilizing a transanal, circular stapler. Three patients had an S-pouch constructed by suture technique. Fecal diversion was accomplished with a 25-mm intraluminal bypass tube (Coloshield™; Deknetel, Fall River, MA) in all cases. There was no mortality. There were no anastomotic complications or morbidity related to the bypass tube. The tube dislodged and passed between days 18 and 26 (mean, 22.1 days). All patients had three to six bowel movements per 24 hours, and all are continent day and night. This experience suggests that, in selected patients, the intraluminal bypass tube may be an excellent alternative to diverting ileostomy.
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References
Metcalf AM, Dozois RR, Kelly KA, Beart RW Jr, Wolff BG. Ileal “J” pouch-anal anastomosis: clinical outcome. Ann Surg 1985;202:735–9.
Parks AG, Nichols RJ. Proctocolectomy without ileostomy for ulcerative colitis. BMJ 1978;2:85–8.
Utsunomiya J, Iwama T, Imajo M,et al. Total colectomy, mucosal proctectomy, and ileoanal anastomosis. Dis Colon Rectum 1980;23:459–66.
Heald RJ, Allen DR. Stapled ileo-anal anastomosis: a technique to avoid mucosal proctectomy in the ileal pouch operation. Br J Surg 1986;73:571–2.
Cohen Z, McLeod RS, Stern H, Grant D, Nordgren S. The pelvic pouch and ileoanal anastomosis procedure: surgical technique and initial results. Am J Surg 1985;150:601–7.
Pemberton J, Kelly KA, Beart RW Jr, Dozois RR, Wolff BG, Ilstrup DM. Ileal pouch-anal anastomosis for chronic ulcerative colitis: long-term results. Ann Surg 1987;206:504–13.
Becker JM, Raymond JL. Ileal pouch-anal anastomosis: a single surgeon's experience with 100 consecutive cases. Ann Surg 1986;204:375–83.
Rothenberger D, Vermeulen FD, Christenson CE,et al. Restorative proctocolectomy with ileal reservoir and ileoanal anastomosis. Am J Surg 1983;145:82–8.
Dozois RR, Goldberg SM, Rothenberger DA,et al. Restorative proctocolectomy with ileal reservoir. Int J Colorectal Dis 1986;1:2–19.
Peck DA. Stapled ileal reservoir to anal anastomosis. Surg Gynecol Obstet 1988;166:562–4.
Lavery IC, Tuckson WB, Easley KA. Internal anal sphincter function after total abdominal colectomy and stapled ileal pouch-anal anastomosis without mucosal proctectomy. Dis Colon Rectum 1989;32:950–3.
Galandiuk S, Wolff BG, Dozois RR, Beart RW Jr. Ileal pouch-anal anastomosis without ileostomy. Dis Colon Rectum 1991;34:870–3.
Matikainen M, Santavirta J, Hiltunen KM. Ileoanal anastomosis without covering ileostomy. Dis Colon Rectum 1990;33:384–8.
Ravo B, Ger R. A preliminary report on the intracolonic bypass as an alternative to temporary colostomy. Surg Gynecol Obstet 1984;159:541–5.
Ravo B, Mishrick A, Addei K,et al. The treatment of perforated diverticulitis by one-stage intracolonic bypass procedure. Surgery 1987;102:771–6.
Sackier JM, Wood CB. Ulcerative colitis and polyposis coli: surgical options. Surg Clin North Am 1988;68:1319–38.
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Launer, D.P., Sackier, J.M. Pouch-anal anastomosis without diverting ileostomy. Dis Colon Rectum 34, 993–998 (1991). https://doi.org/10.1007/BF02049963
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DOI: https://doi.org/10.1007/BF02049963