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PubMed1994

The ileo-anal reservoir: results from an evolving use of stapling devices.

Thirteen patients had a hand-sewn pouch-anal anastomosis (group A) during restorative proctocolectomy for familial adenomatous polyposis. Median length of follow-up since ileostomy closure was 41.5 months (range 30-56 months). Median stool frequency per 24 h was 4.5 (range 2-5). Six patients were fully continent, three were incontinent to flatus and three patients were occasionally incontinent to liquid stool. Three patients suffered nocturnal seepage but all patients could defer the urge to defaecate by at least 15 min. Fourteen patients (familial adenomatous polyposis: seven; ulcerative colitis: six; intractable constipation: one), had a totally stapled ileal J pouch and pouch-anal anastomosis (group B). Five patients did not have a defunctioning ileostomy while nine patients did. Median follow-up after ileostomy closure or one-stage restorative proctocolectomy was 17.5 months (range 1-30 months). Median frequency of bowel movement per 24 h was 4 (range 2-6). Eleven patients had full continence and three patients suffer occasional incontinence to liquid stools. Two patients have nocturnal seepage but all can defer the urge to defaecate by more then 15 min. There was no significant difference in physiological parameters between the two groups.

Adolescent↗
PubMedDate not supplied

[The prevention of the aorto-mesenteric compression syndrome in interventions for ileoanal anastomoses].

Restorative proctocolectomy with ileal-anal anastomosis can induce a duodenal stenosis due to the compression between superior mesenteric artery (SMA) and aorta when the ileum is pulled-down to the anus stretching the SMA. This situation may require prolonged nasogastric intubation or even surgery. In our experience this occurred in 10% of pts. Aiming to avoid this complication we have performed an intestinal derotation just before ileal-anal anastomosis abolishing any possibility of duodenal compression. Comparing this latter group of patients to those who didn't receive intestinal derotation, we observed a significant reduction of nasogastric tube drainage and of the nasogastric intubation time. We think that intestinal derotation could be effective in preventing SMA syndrome after restorative proctocolectomy and ileal-anal anastomosis.

Adolescent↗
PubMed2004

Working capacity and resting energy expenditure after ileal pouch-anal anastomosis.

BACKGROUND: The aim was to evaluate the working capacity and resting energy expenditure in patients who had undergone restorative proctocolectomy. METHODS: Of 72 patients operated on between April 1990 to September 1998, 51 were eligible and 38 participated in the study. Resting energy was assessed by indirect calorimetry, and working capacity by ergospirometry on an exercise bicycle. RESULTS: The median functional score was 2 (range 0-7). Oxygen uptake during rest was reduced for men compared with predicted values. The corresponding values for women were in keeping with predicted values. The median working capacity was 96 (range 59-102) per cent for women and 91 (range 51-113) per cent for men, compared with reference values of maximum workload based on age, height and sex. There was no correlation between functional score and any other variable measured. CONCLUSION: Patients who have undergone restorative proctocolectomy for ulcerative colitis have normal resting energy expenditure and working capacity.

Adult↗
PubMed2005

Surgical treatment and long-term outcome of patients with familial adenomatous polyposis: 16 years experience at the Tel Aviv Sourasky Medical Center.

BACKGROUND: Restorative proctocolectomy eliminates the risk of colorectal cancer in patients with familial adenomatous polyposis. Complications and extra-intestinal manifestations are inherent to the procedure. OBJECTIVES: To evaluate operative procedures, complications, early and late results and long-term functional outcome in FAP patients operated in our department. METHODS: The study group included all patients with FAP who were operated between 1988 and 2003. Demographic data, length of follow-up, complications, colorectal cancer, pouch function and extracolonic manifestations were recorded. RESULTS: Median age at surgery was 33 years (range 13-61 years). The final operative breakdown was: 48 proctocolectomies, 41 ileal pouch-anal anastomoses, 2 Kock's pouch, 5 permanent ileostomies, and 2 colectomies with ileorectal anastomosis. There was no perioperative mortality. Early and late complications occurred in 20 and 9 patients, respectively. Twelve patients required reoperation. Colorectal carcinoma was diagnosed in eight patients, three of whom were in an advanced stage. The mean follow-up was 74 months (range 3-288 months). Four patients were lost to follow-up. Extracolonic manifestations developed in 38 patients, including desmoid tumors (in 12), duodenal adenomas (in 9), pouch adenomas (in 5), and rectal stump adenomas (in 3). Two patients died (4%) because of desmoid tumor and malignant fibrous histiocytoma. At last follow-up, 37 IPAA patients have (median) six bowel movements/24 hours and good fecal control. CONCLUSIONS: Restorative proctocolectomy can be performed with low mortality, acceptable morbidity, and good functional results. Patients should be closely followed after surgery for development of other manifestations of the syndrome. Relatives of the affected patients should be referred to a specialist multidisciplinary clinic.

Adenomatous Polyposis Coli↗
PubMed1997

The surgical management of nonspecific inflammatory bowel disease: a small personal experience.

AIMS: To document the surgical management of patients with non specific inflammatory bowel disease managed in the colorectal service, University Department of Surgery, Wellington School of Medicine. METHODS: Retrospective analysis of patients managed between April 1975 and March 1990. RESULTS: Sixty five patients had inflammatory bowel disease. Twenty one (11 males) had ulcerative colitis and 44 (18 males) had Crohn's disease. There were no Maori. One hundred and twenty three operations were performed overall. Ten patients with ulcerative colitis were operated upon as emergencies. Five presented with fulminating disease. Six patients successfully underwent restorative proctocolectomy although one was subsequently thought to have had Crohn's disease. Overall there was one postoperative death. Crohn's disease patients underwent a total of 91 operations. Twenty nine operations were elective and 15 emergency during the first surgical admission. The commonest indication for surgery was stricture. The commonest operation performed was right hemicolectomy. Chest, wound and central line sepsis were the commonest postoperative problems. There were two postoperative deaths. Six patients favoured a series of relatively minor perineal operations to proctectomy. CONCLUSION: A cautious staged approach to the surgical management of inflammatory bowel disease patients resulted in only three deaths-an overall mortality rate of 4.6%. Accordingly we advocate a policy of expectant surgery to relieve symptoms or correct complications in patients with Crohn's disease. We believe that patients requiring surgery for ulcerative colitis should be offered the choice of either restorative proctocolectomy or panproctocolectomy and ileostomy.

Adult↗
PubMed1999

"Cuffitis" and inflammatory changes in the columnar cuff, anal transitional zone, and ileal reservoir after stapled pouch-anal anastomosis.

PURPOSE: During the past eight to ten years most surgeons have adopted the double-stapled technique to accomplish the pouch-anal anastomosis in restorative proctocolectomy for ulcerative colitis. Little attention has been focused on the functional implications of retaining a segment of diseased columnar mucosa in the upper anal canal. The aim of this study was to investigate clinically significant inflammation in the columnar cuff. METHOD: In all, 113 patients were studied and 715 biopsies were performed during a 2.5-year period. Biopsy specimens were taken from two or three sites, including the columnar cuff, ileal pouch, and anal transitional zone. Acute and chronic inflammation was scored for biopsy specimens from all three sites and compared with endoscopic assessment and pouch function. RESULTS: In the columnar cuff acute histologic inflammation was found in 13 percent of patients, and in 9 percent this was symptomatic during follow-up and was accompanied by evidence of endoscopic inflammation. Most patients had mild inflammation in the cuff that persisted over time. Inflammation in the pouch, pouch frequency, and anastomotic height were not related to columnar cuff inflammation. CONCLUSIONS: Cuffitis is a cause of pouch dysfunction after a double-stapled restorative proctocolectomy. We propose a triad of diagnostic criteria, including symptoms and endoscopic and histologic inflammation.

Anal Canal↗
PubMed2006

Timing of restorative proctectomy following subtotal colectomy in patients with inflammatory bowel disease.

BACKGROUND: There is no general consensus regarding the timing of restorative proctocolectomy (RPC) in patients who have undergone subtotal colectomy with end ileostomy (STC). The aim of this study was to determine the impact of timing of RPC in patients who have undergone subtotal colectomy and end ileostomy for inflammatory bowel disease (IBD). METHODS: A retrospective medical record review of patients who had undergone RPC after STC was undertaken. Patients were divided into 3 groups according to timing of the completion proctectomy: 7 months. RESULTS: From 1990 to 2000, 91 patients had undergone RPC after STC for IBD. There were no statistically significant differences among the three groups relative to mean age, gender, final diagnosis, duration of disease, body mass index, comorbidity, extraintestinal manifestations, use of immunuosuppressives, or operative time. The number of intra-operative complications were significantly higher in the <or= 3 month group compared to the other groups. There was no significant difference in the overall incidence of postoperative complications among the 3 groups. Postoperative fistulas were significantly more common after RPC in Groups 1 and 2 as compared to Group 3. CONCLUSION: Restorative proctocolectomy performed within 3 months after the initial subtotal colectomy was associated with a significant increase in the incidence of intra-operative complications. Although this increase was not statistically significant, there was a significantly higher incidence of fistula formation when RPC was undertaken at up to 7 months after the subtotal colectomy for IBD. Thus, if possible, early RPC after subtotal colectomy should be discouraged.

Adult↗
PubMed1999

Ileal J-pouch--anal anastomosis, sexual dysfunction, and fertility.

BACKGROUND: Our aim was to establish what kind of changes take place in sexual functions after restorative proctocolectomy and ileoanal anastomosis with J-pouch (IAA) and whether the operation alters fertility. METHODS: One hundred and ten consecutive patients who underwent IAA operation for ulcerative colitis at our institute were sent a questionnaire after at least 2 years' follow-up with special emphasis on sexual functions. Analysis was made by an independent researcher. RESULTS: Ninety-five patients (86.7%) responded to the questionnaire. The mean follow-up of the patients was 71.5 months (range, 30-128 months). The median age of the 51 women in this study was 39.0 years (range, 23-74 years). Dyspareunia increased after the operation, but sexual satisfaction improved. The operation seems to reduce fertility slightly in women, and the rate of spontaneous abortion may be higher than in the normal population. The median age of the men was 43.0 (25-69) years. One (2.3%) case of retrograde ejaculation and six (14.6%) cases of erectile function problems were reported after the operation. The fear of leakage during coitus were reduced. CONCLUSIONS: Sexual satisfaction is improved after operation, mainly due to improved general health, despite minor disturbances in sexual function. There may be a risk of decreased fertility after restorative proctocolectomy.

Adult↗
PubMed2003

Long-term results of ileal pouch-anal anastomosis in Crohn's disease.

The unexpected diagnosis of Crohn's disease (CD) after restorative proctocolectomy is a relatively frequent occurrence. We report a retrospective analysis of the long-term development of patients with an ileal pouch-anal anastomosis (IPAA) in whom the definitive anatomopathological diagnosis was CD, and compare their development with that of patients in whom the diagnosis of ulcerative colitis (UC) was confirmed. We reviewed the clinical data of 112 patients with an IPAA. The definitive diagnosis was CD in 12, and UC in the rest. The mean follow-up period was 76 months (range 12 to 192). We analyzed and compared the epidemiologic and clinical data, postoperative complications, functional results, anxiety, and quality of life in the two groups. Postoperative morbidity and the degree of satisfaction were similar in the two groups. The test showed a lower level of anxiety and higher quality of life in patients with CD. Of all the functional parameters studied, only urgency of defecation presented a higher risk in the CD group (HR: 4.13, CI: 1.41-12.04, p = 0.027). Despite the fact that a diagnosis of CD is currently considered a contraindication for an IPAA, some patients with secondary diagnosis of CD have good functional outcome and quality of life after restorative proctocolectomy. Closure of the temporary ileostomy may be justified in these patients.

Adolescent↗
PubMed2003

Rectal cancer and ulcerative colitis: does it change the therapeutic approach?

OBJECTIVE: The aim of this study was to examine the incidence of coexisting colorectal cancer in ulcerative colitis in a population of patients undergoing ileal pouch anal anastomosis. The frequency of rectal cancer in this population, surgical intervention, general outcomes and cancer recurrence are described. METHODS: Data on 1850 patients undergoing restorative proctocolectomy from 1983 to 2001 were reviewed. Information was gathered from data in the department's pelvic pouch database, as well as pathology and surgical reports. Follow-up questionnaires routinely sent to patients as part of the database were included in the analysis to determine current functional status. Mean follow-up period was 7.5 years after surgery. RESULTS: Seventy patients had coexisting colorectal cancer at time of IPAA. 7 (10%) of cancers were incidental. Pre-operative duration of disease was 18.6 years. Twenty-six of the cancers were rectal cancers. The most common form of anastomosis in the rectal cancers was mucosectomy, especially in pre-operatively known rectal cancer or low lying dysplasia. Preferred surgical technique for rectal cancer in mucosal ulcerative colitis (UC) included high ligation of mesenteric vessels with radical colectomy and taped occlusion of the rectum with irrigation of the rectal stump with Turnbull solution prior to mucosectomy. Patients with Stage 3 cancers received postoperative chemotherapy. Post-operative radiation therapy was not commonly recommended. Five of 70 patients were deceased from metastatic colon cancer; 55 patients were confirmed alive with good to excellent pouch function with a follow-up range of 1-17 years. CONCLUSION: Restorative proctocolectomy with ileal pouch anal anastomosis is a successful surgical approach for patients with coexisting colorectal cancer in UC. When the appropriate surgical technique is used in patients with colon or rectal cancer, along with adjuvant chemotherapy when appropriate, prognosis and function is very good.

Anastomosis, Surgical↗
PubMed2001

Long-term follow-up after ileoanal pouch procedure: algorithm for diagnosis, classification, and management of pouchitis.

PURPOSE: Inflammation of the ileoanal pouch (pouchitis) is one of the main complications after restorative proctocolectomy, yet its cause remains poorly understood. A standardized definition and diagnostic procedures in pouchitis are lacking. METHOD: We analyzed all cases of pouchitis occurring in a group of 308 patients (210 with ulcerative colitis, 98 with familial adenomatous polyposis) who took part in a prospective long-term follow-up program. The severity of pouchitis was measured using a pouchitis activity score (Heidelberg Pouchitis Activity Score). An algorithm for the classification and management of pouchitis was established which enables the clinician: 1) to determine the severity of pouchitis, 2) to differentiate between primary pouchitis and pouchitis caused by surgical complications (secondary pouchitis), and 3) to evaluate the course (acute vs. chronic (> 3 months)). RESULTS: The median duration of follow-up was 48 (range, 13-119) months. At least one episode of pouchitis was diagnosed in 29 percent of patients with ulcerative colitis and in 2 percent of familial adenomatous polyposis patients. Secondary pouchitis occurred in 6 percent of ulcerative colitis patients and was cured by surgical treatment in 13 (87 percent) of 15 cases. Primary pouchitis was diagnosed in 23 percent of ulcerative colitis patients, including 6 percent of all ulcerative colitis patients with chronic primary pouchitis. The latter showed poor response to medical treatment. In one case multifocal high-grade dysplasia occurred. Histologic examination of the excised pouch identified a carcinoma originating from the ileal mucosa. CONCLUSIONS: Ulcerative colitis patients after restorative proctocolectomy face a high risk of developing pouchitis. The algorithm used in this study was highly efficient in identifying patients with a secondary pouchitis who require surgical treatment and patients with chronic primary pouchitis. For the latter, long-term surveillance seems mandatory because of the risk of malignant transformation of the pouch mucosa.

Acute Disease↗
PubMed2001

Stapled ileoanal pouches without loop ileostomy: a prospective study in 86 patients.

In restorative proctocolectomy the use of a stapling technique to construct an ileal pouch with anal anastomosis offers an alternative to the hand-sewn technique following mucosectomy; a temporary defunctioning loop ileostomy may reduce the consequences of an anastomotic leakage, however it may entail discomfort for the patient, an additional operation, possible complications, and longer total hospital stay. This prospective study evaluated the peri- and postoperative courses in 86 consecutive, referred patients receiving ileal pouch-anal anastomosis using the stapling technique to construct the ileal pouch and ileoanal anastomosis, omitting the defunctioning loop ileostomy except in cases of increased risk of ileoanal anastomotic insufficiency according to defined criteria. Follow-up time was 36-96 months. Patients undergoing primary loop ileostomy stayed a median of 19 days in hospital, as opposed to a median of 9 days in those who did not. Eight patients developed pelvic sepsis that demanded a secondary defunctioning loop ileostomy, and five showed symptoms arising from relapsing inflammation in residual rectal mucosa; in three of these, a secondary transanal mucosectomy covered by a loop ileostomy was necessary. During the follow-up period ten patients had bowel obstructions that demanded surgery; two developed late pouch-vaginal fistulas, and one a fistula from the J-limb to the abdominal scar. There was one case of pouch procidentia. At 12-month follow-up the median evacuation frequency was 6 per 24 h, the incidence of minor incontinence was about 10%, and urgency to evacuate occurred in about 10%. None of the patients experienced any major incontinence. The stapling technique and omission of the defunctioning loop ileostomy in restorative proctocolectomy were thus a comparatively reliable and time-saving method with short total hospital stay. In patients at increased risk of anastomotic complications, however, a defunctioning loop ileostomy is recommended. We believe it is important to perform an exact dissection into the anal canal to avoid a residual rectal mucosa that may be inflamed or even become dysplastic.

Adolescent↗
PubMed1997

Straight ileoanal anastomosis with multiple ileal myotomies as an alternative to pelvic pouch.

UNLABELLED: An alternative technique of restorative proctocolectomy, by means of straight ileoanal anastomosis with multiple myotomies (SIAM) of the terminal ileum in 15 patients, nine with familial adenomatous polyposis (FAP) and six with ulcerative colitis (UC) is reported. SURGICAL TECHNIQUE: Eight to ten longitudinal myotomies (3-4 cm long, on three different circumferential sites) were performed on the terminal ileum for a total length of 12-14 cm. CLINICAL RESULTS: At a mean follow up of 44 months (range 3-84 months) from the closure of the ileostomy, daytime continence was achieved in all the patients; stool frequency per 24 hours (+/- SD) was 4.1 +/- 1.8 for FAP patients and 5.8 +/- 1.7 for UC patients; nocturnal defecation was 1.0 +/- 0.5 and 1.2 +/- 0.8 for FAP and UC patients respectively; frequent nocturnal soiling was present in 2/5 of UC patients, and in 3/9 of FAP patients. SIAM failed in one UC patient that was converted to an ileoanal reservoir because of poor functional result. Signs of ileal mucosal inflammation were never observed at endoscopic examination. Histopathological assessment showed no evidence of acute terminal ileitis. MANOMETRIC FINDINGS: A significant postoperative reduction in anal resting pressure was observed after SIAM. Neither the absence of anal inhibitory reflex nor the presence of high pressure waves generated in the terminal ileum during air insufflation were related to the presence of soiling. The closure of the loop ileostomy was followed by an increased capacity and distensibility of the terminal ileum. Values of neorectal compliance were similar in FAP and UC patients although FAP patients were able to reach higher values of maximum tolerated volume and pressure. CONCLUSIONS: 1) SIAM can be an alternative to pelvic pouch in patients who have undergone restorative proctocolectomy when the construction of the pouch is not feasible. 2) The functional result observed after SIAM has been shown to be similar to that observed after pouch construction.

Adenomatous Polyps↗
PubMed2004

Large villous adenomas arising in ileal pouches in familial adenomatous polyposis: report of two cases.

A restorative proctocolectomy or ileal pouch procedure is one of the main surgical options for patients with familial adenomatous polyposis. The main premise underlying the recommendation of a pouch procedure rather than an ileorectal anastomosis is that it minimizes the risk of rectal cancer. Several studies have evaluated the risk of developing pouch adenomas. There also have been reports of pouch cancers, although the long-term risk of malignancy cannot yet be quantified. Most pouch polyps reported have been small tubular adenomas with mild dysplasia. A 19-year-old female with familial adenomatous polyposis had a colectomy and ileorectal anastomosis. Progressive rectal polyposis led to a restorative proctocolectomy at aged 38 years. Four years later, a large, 3-cm x 2-cm, villous adenoma was identified in the mid pouch, which was resected endoscopically. A 32-year-old male with familial adenomatous polyposis had a restorative proctocolectomy. Ten years after surgery, pouch endoscopy revealed several large, villous adenomas arising from the pouch mucosa. These advanced polyps may present a significant risk for cancer development and require close endoscopic surveillance. These findings strengthen the recommendation for careful regular endoscopic surveillance of familial adenomatous polyposis pouches and the evaluation of management and treatment strategies for pouch adenomas.

Adenoma, Villous↗
PubMedDate not supplied

[Total proctocolectomy with an ileoanal anastomosis and reservoir].

The following report documents the initial experience (13 cases) and the one year functional and quality of life results after restorative proctocolectomy procedures in the Surgery Clinic of Fundeni Hospital. The histologic preoperative diagnosis was ulcerative colitis in 7 patients (53.84%) and familial polyposis in 6 patients (46.16%). 80% of patients experienced at least one postoperative complication after pouch construction or ileostomy closure. There was a single death in our patient group. This occurred in a patient with malignized polyposis, who died in the first 24 hours after operation from bilateral pulmonary emboli. The necropsy exam has shown also a metastatic nodule of the liver. The most frequent complication in our series was the small bowel obstruction and the pouch-anal anastomosis leak (30.76%). Patients' follow-up was achieved by means of a questionnaire which assessed pouch function at follow-up visit at 1 month, 3 month, 6 month and one year after the ileostomy closure. Quality of life was also assessed by that questionnaire and included injury into aspects of occupational, social and sexual function. The functional and quality of life results in this series was very similar to that reported by other authors who have performed restorative proctocolectomy for ulcerative colitis and familial polyposis.

Adenomatous Polyposis Coli↗
PubMed1996

[Surgery for ulcerative colitis. Treatment with proctocolectomy, stapled ileum-J-pouch, stapled pouch-anal anastomosis and temporary ileostomy].

Thirty-two patients with ulcerative colitis, median age 29 (range 14-49), were submitted to restorative proctocolectomy. Twenty-five patients had a three-stage procedure and seven had a two-stage procedure. A stapled J-pouch was formed, and a pouch-anal anastomosis was created by the double stapling technique. A temporary end ileostomy was closed through peristomal incision after three months. There were no pouch failures and no cases of pouch-anal anastomosis leakage. In one patient secondary mucosectomy and neo-anastomosis became necessary due to severe inflammation of remnant rectal mucosa. Five patients were operated for small bowel obstruction, and two had to have a dilatation of a slight stricture of the pouch-anal anastomosis. In two patients the final diagnosis was verified or probable Crohns disease, of whom one developed recurrence of a previous rectovaginal fistula. Twenty-seven patients have had the ileostomy closed for more than one month, 25 of these (93%) were fully continent three months after ileostomy closure and later on. After one year the patients had median five (range 3-9) bowel movements per day. It is concluded that restorative proctocolectomy with a stapled J-pouch-anal anastomosis and a temporary end ileostomy for ulcerative colitis carries few complications and provides a good functional result.

Adolescent↗
PubMed2001

[Video-assisted total proctocolectomy with ileoanal anastomosis].

The indication for laparoscopy in digestive surgery has evolved with the development of the laparoscopic material as well its increasingly frequent practice in the medical community. Those complex operations such as restorative proctocolectomy require a high level of technical skill as well as a specifically designed operative approach. The study aim was to report our experience of the video-assisted approach to restorative proctocolectomy.

Anastomosis, Surgical↗
PubMedDate not supplied

[Surgical treatment in ulcerative rectocolitis . Analysis of a 24 years experience of 50 patients].

Ulcerative colitis (UC) is an inflammatory bowel disease that may be cured by surgery being indicated for emergency situations resulting from complications of fulminant disease and for elective indications. We analyzed the last 24 years experience regarding 50 patients surgically treated for ulcerative colitis in the Center of General Surgery and Liver Transplantation of Fundeni Clinical Institute. The indications for surgery were: failure of medical treatment in 22 patients, acute disease with complications in 20, chronic complications in 8 cases. We used the following surgical procedures: total proctocolectomy in all 2 cases with associated rectal cancer, total colectomy with ileo-rectal anastomosis (one staged or two staged procedures) in 31, and restorative proctocolectomy in 17 cases (in all cases as a 2 or 3 staged procedure). In acute disease with complications we have performed total colectomy with terminal ileostomy, closure of the rectal stump, or exteriorization of the sigmoid stump in a mucous fistula. The gravity of acute complications does not justify the use of palliative procedures such as ileostomy, colostomy or Hartmann procedure because the mortality rate of these operations is higher than the postoperative mortality rate of total colectomy performed in emergency. Even in the elective surgery, when the patients are in a poor condition, nutritionally depleted, taking large doses of steroids or immunosuppressive drugs, we prefer the staged procedure. Total proctocolectomy is performed only in the cases of ulcerative colitis associated with rectal cancer, severe perianal disease, sphincter incontinence. Total colectomy with ileo-rectal anastomosis is indicated when the rectal stump has minimal inflammatory lesions. Restorative proctocolectomy is the surgery of choice for UC, the functional results being comparable with those of total colectomy with ileo-rectal anastomosis, but having the advantage of curing the disease. The global mortality rate was 12% (6 patients).

Anastomosis, Surgical↗