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Annals of Surgery logoLink to Annals of Surgery
. 1983 Jan;197(1):99–105.

The endorectal pull-through for the management of ulcerative colitis in children and adults.

A G Coran, T M Sarahan, T L Dent, R Fiddian-Green, J R Wesley, F T Jordan
PMCID: PMC1352861  PMID: 6848060

Abstract

Between June 1977 and November 1981, 26 children and adults with ulcerative colitis have undergone a total colectomy, an endorectal dissection of the rectal mucosa, and an ileoanostomy. A combined abdominoperineal approach was used to perform the operation, and the mucosal-submucosal rectal tube was dissected out intact from the abdominal approach. Every patient survived the operation and showed marked clinical improvement presumably due to resection of the diseased colon. Three patients developed intestinal obstruction that was successfully treated with an enterolysis. A rectal cuff abscess and a retroperitoneal abscess were the only other complications. The postoperative stooling pattern of each patient was obtained through detailed interviews. All the patients were continent during the day and at night one month after surgery. Twenty-two patients had a median stool frequency of seven per 24 hours one month after surgery. At one year, the average number of stools was seven per day. Six patients experienced a stool frequency of seven per 24 hours two years after surgery. The results with this series of patients had encouraged the authors to continue to recommend this approach to children and adults with ulcerative colitis, since it offers an alternative lifestyle that is more attractive to certain patients than the presence of an abdominal stoma.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BROOKE B. N. The management of an ileostomy, including its complications. Lancet. 1952 Jul 19;2(6725):102–104. doi: 10.1016/s0140-6736(52)92149-1. [DOI] [PubMed] [Google Scholar]
  2. Boley S. J. An endorectal pull-through operation with primary anastomosis for Hirchsprung's disease. Surg Gynecol Obstet. 1968 Aug;127(2):353–357. [PubMed] [Google Scholar]
  3. Coran A. G., Weintraub W. H. Modification of the endorectal procedure for Hirschsprung's disease. Surg Gynecol Obstet. 1976 Aug;143(2):277–282. [PubMed] [Google Scholar]
  4. Fonkalsrud E. W. Total colectomy and endorectal ileal pull-through with internal ileal reservoir for ulcerative colitis. Surg Gynecol Obstet. 1980 Jan;150(1):1–8. [PubMed] [Google Scholar]
  5. Gelernt I. M., Bauer J. J., Kreel I. Continent ileostomy in the pediatric patient. J Pediatr Surg. 1976 Oct;11(5):773–779. doi: 10.1016/0022-3468(76)90102-0. [DOI] [PubMed] [Google Scholar]
  6. Glotzer D. J., Pihl B. G. Preservation of continence after mucosal graft in the rectum and its feasibility in man. Am J Surg. 1969 Mar;117(3):403–409. doi: 10.1016/0002-9610(69)90379-1. [DOI] [PubMed] [Google Scholar]
  7. Jordan F. T., Coran A. G., Weintraub W. H., Wesley J. R. An evaluation of the modified endorectal procedure for Hirschsprung's disease. J Pediatr Surg. 1979 Dec;14(6):681–685. doi: 10.1016/s0022-3468(79)80244-4. [DOI] [PubMed] [Google Scholar]
  8. Jordan F. T., Coran A. G., Wesley J. R. Modified endorectal procedure for management of long-segment aganglionosis. Ann Surg. 1981 Jul;194(1):70–75. doi: 10.1097/00000658-198107000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Kock N. G. Ileostomy without external appliances: a survey of 25 patients provided with intra-abdominal intestinal reservoir. Ann Surg. 1971 Apr;173(4):545–550. doi: 10.1097/00000658-197104000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Martin L. W., LeCoultre C., Schubert W. K. Total colectomy and mucosal proctectomy with preservation of continence in ulcerative colitis. Ann Surg. 1977 Oct;186(4):477–480. doi: 10.1097/00000658-197710000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Parks A. G., Nicholls R. J. Proctocolectomy without ileostomy for ulcerative colitis. Br Med J. 1978 Jul 8;2(6130):85–88. doi: 10.1136/bmj.2.6130.85. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Peck D. A. Rectal mucosal replacement. Ann Surg. 1980 Mar;191(3):294–303. doi: 10.1097/00000658-198003000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. SOAVE F. A NEW SURGICAL TECHNIQUE FOR TREATMENT OF HIRSCHSPRUNG'S DISEASE. Surgery. 1964 Nov;56:1007–1014. [PubMed] [Google Scholar]
  14. Telander R. L., Perrault J. Total colectomy with rectal mucosectomy and ileoanal anastomosis for chronic ulcerative colitis in children and young adults. Mayo Clin Proc. 1980 Jul;55(7):420–424. [PubMed] [Google Scholar]
  15. Telander R. L., Smith S. L., Marcinek H. M., O'Fallon W. M., van Heerden J. A., Perrault J. Surgical treatment of ulcerative colitis in children. Surgery. 1981 Oct;90(4):787–794. [PubMed] [Google Scholar]

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