78 Steps Health Journal

Ileorectostomy

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Many surgical procedures for acute ulcerative colitis entail a temporary or definitive stoma, with all its attending aesthetic, emotional and sexual implications. Total abdominal colectomy with temporary ileostomy and subsequent ileorectostomy is more acceptable, particularly for young people [41]. However, there are many deterring factors against routine acceptance of ileorectostomy. Although functional results are satisfactory and many patients are quite pleased with the outcome, bowel movement frequency range is between two and ten per day, with a mean of four to five per day. Approximately 50% of patients require occasional antidiarrhoeal agents. Normal continence is generally reported, but a few patients feel social limitations for leakage or soiling.

Proctitis, with progression of disease in the rectal

Fig. 6. Ileorectal end-to-end mechanical anastomosis

Fig. 6. Ileorectal end-to-end mechanical anastomosis

Fig. 7. Restorative proctocolectomy: preparation and closure of rectal stump

Fig. 7. Restorative proctocolectomy: preparation and closure of rectal stump stump leading to subsequent proctectomy, is a potential disadvantage. Development of cancer in the residual rectum, with a cumulative risk of 15% at 30 years, is one of the main arguments against ileo-proctostomy. Based on many observations, patients with cancer or severe dysplasia in the resected colon are not candidates for ileoproctostomy because of the potential development of cancer in the retained rectum. Therefore, if ileorectostomy is performed, the rectal stump must be kept under close endo-scopic evaluation. Besides, high incidence of anastomotic leakage has been documented in many studies [42,43]. Only patients who have none of the high risk factors should be considered for ileorectostomy; the prognostic significance of disease in the rectum at time of anastomosis, level of anastomosis and patient age at operation should be carefully evaluated (Fig. 6).

Approximately 30% of patients submitted to ileo-rectostomy will require a subsequent proctectomy, but quality of life is satisfactory in about 55% of patients. Young patients have higher incidence of subsequent proctectomy.