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. 1990 Sep;212(3):242–248. doi: 10.1097/00000658-199009000-00002

A personal experience with 100 consecutive total colectomies and straight ileoanal endorectal pull-throughs for benign disease of the colon and rectum in children and adults.

A G Coran 1
PMCID: PMC1358148  PMID: 2396880

Abstract

In 1974 total colectomy and ileoanal straight endorectal pull-through (ERPT) were first used at our institution for the definitive management of total colonic Hirschsprung's disease in infants and children. Early success with this operation encouraged us to use this procedure in children and adults with ulcerative colitis and familial polyposis in 1977. Since 1974 we have performed total colectomy and straight ileoanal ERPT on 100 consecutive patients with ulcerative colitis (79), familial polyposis (19), and total colonic Hirschsprung's disease (10). Patients who have undergone a colectomy and ERPT but have not had their temporary ileostomy closed have been excluded from this report. This group of patients represents the only large series of straight ERPTs available for comparison with the various reservoir modifications that have been reported. All operations were performed under the direction of the author. The mean age at surgery was 20.6 +/- 9.8 years, with a range of 1 to 48 years. Forty-six patients were younger than 18 years at the time of operation. All patients with ulcerative colitis and familial polyposis underwent a temporary loop ileostomy with total abdominal colectomy with ERPT; the 10 infants and children with Hirschsprung's disease underwent the total colectomy and ERPT without a back-up ileostomy. There were two deaths in this series, one from fulminate hepatic failure in the late postoperative period and the other from multiple bowel fistulas and sepsis in a teenager with Crohn's disease, in whom the initial diagnosis was ulcerative colitis. Follow-up has ranged from 3 months to 15 years. There were 13 cases of adhesive bowel obstruction, seven of which required an enterolysis. Pelvic sepsis occurred in three patients, two of whom required operative drainage. Two women developed rectovaginal fistulas, which healed with temporary diversion. Minor wound infections occurred in five patients. There were no anastomotic leaks, nor were any cases of pouchitis encountered. In five patients permanent conversion to a Brooke ileostomy was required. Mean stool frequency 3 years after surgery was 7.7 per 24 hours. Daytime continence was achieved in all patients. Occasional nocturnal soiling occurred in 11.1% of patients at 1 year and was absent by 3 years. Neither age nor diagnosis (ulcerative colitis versus familial polyposis) affected stool frequency.(ABSTRACT TRUNCATED AT 400 WORDS)

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Selected References

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  1. Bank E. R., White S. J., Coran A. G. The radiographic appearance of the endorectal pull-through. Pediatr Radiol. 1986;16(3):216–221. doi: 10.1007/BF02456290. [DOI] [PubMed] [Google Scholar]
  2. Becker J. M., Raymond J. L. Ileal pouch-anal anastomosis. A single surgeon's experience with 100 consecutive cases. Ann Surg. 1986 Oct;204(4):375–383. doi: 10.1097/00000658-198610000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Cohen Z., McLeod R. S., Stern H., Grant D., Nordgren S. The pelvic pouch and ileoanal anastomosis procedure. Surgical technique and initial results. Am J Surg. 1985 Nov;150(5):601–607. doi: 10.1016/0002-9610(85)90445-3. [DOI] [PubMed] [Google Scholar]
  4. Coran A. G., Jordan F. T., Wesley J. R. The endorectal pull-through for the management of familial polyposis. Int Surg. 1985 Oct-Dec;70(4):335–337. [PubMed] [Google Scholar]
  5. Coran A. G. New surgical approaches to ulcerative colitis in children and adults. World J Surg. 1985 Apr;9(2):203–213. doi: 10.1007/BF01656313. [DOI] [PubMed] [Google Scholar]
  6. Coran A. G., Sarahan T. M., Dent T. L., Fiddian-Green R., Wesley J. R., Jordan F. T. The endorectal pull-through for the management of ulcerative colitis in children and adults. Ann Surg. 1983 Jan;197(1):99–105. [PMC free article] [PubMed] [Google Scholar]
  7. Cranley B., McKelvey S. T. Ileal reservoirs: an experimental study of motility in the Kock and triplicated pelvic ileal pouches. J Surg Res. 1983 Mar;34(3):279–285. doi: 10.1016/0022-4804(83)90071-9. [DOI] [PubMed] [Google Scholar]
  8. Dozois R. R., Kelly K. A., Welling D. R., Gordon H., Beart R. W., Jr, Wolff B. G., Pemberton J. H., Ilstrup D. M. Ileal pouch-anal anastomosis: comparison of results in familial adenomatous polyposis and chronic ulcerative colitis. Ann Surg. 1989 Sep;210(3):268–273. doi: 10.1097/00000658-198909000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Fonkalsrud E. W. Endorectal ileoanal anastomosis with isoperistaltic ileal reservoir after colectomy and mucosal proctectomy. Ann Surg. 1984 Feb;199(2):151–157. doi: 10.1097/00000658-198402000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Fonkalsrud E. W., Stelzner M., McDonald N. Experience with the endorectal ileal pullthrough with lateral reservoir for ulcerative colitis and polyposis. Arch Surg. 1988 Sep;123(9):1053–1058. doi: 10.1001/archsurg.1988.01400330029003. [DOI] [PubMed] [Google Scholar]
  11. 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]
  12. Harms B. A., Hamilton J. W., Yamamoto D. T., Starling J. R. Quadruple-loop (W) ileal pouch reconstruction after proctocolectomy: analysis and functional results. Surgery. 1987 Oct;102(4):561–567. [PubMed] [Google Scholar]
  13. Heppell J., Kelly K. A., Phillips S. F., Beart R. W., Jr, Telander R. L., Perrault J. Physiologic aspects of continence after colectomy, mucosal proctectomy, and endorectal ileo-anal anastomosis. Ann Surg. 1982 Apr;195(4):435–443. doi: 10.1097/00000658-198204000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. 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]
  15. Kock N. G. Intra-abdominal "reservoir" in patients with permanent ileostomy. Preliminary observations on a procedure resulting in fecal "continence" in five ileostomy patients. Arch Surg. 1969 Aug;99(2):223–231. doi: 10.1001/archsurg.1969.01340140095014. [DOI] [PubMed] [Google Scholar]
  16. Kojima Y., Sanada Y., Fonkalsrud E. W. Comparison of endorectal ileal pullthrough following colectomy with and without ileal reservoir. J Pediatr Surg. 1982 Oct;17(5):653–659. doi: 10.1016/s0022-3468(82)80128-0. [DOI] [PubMed] [Google Scholar]
  17. Martin L. W., Fischer J. E., Sayers H. J., Alexander F., Torres M. A. Anal continence following Soave procedure. Analysis of results in 100 patients. Ann Surg. 1986 May;203(5):525–530. doi: 10.1097/00000658-198605000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. 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]
  19. Morgan R. A., Manning P. B., Coran A. G. Experience with the straight endorectal pullthrough for the management of ulcerative colitis and familial polyposis in children and adults. Ann Surg. 1987 Nov;206(5):595–599. doi: 10.1097/00000658-198711000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Nicholls J., Pescatori M., Motson R. W., Pezim M. E. Restorative proctocolectomy with a three-loop ileal reservoir for ulcerative colitis and familial adenomatous polyposis. Clinical results in 66 patients followed for up to 6 years. Ann Surg. 1984 Apr;199(4):383–388. doi: 10.1097/00000658-198404000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Nicholls R. J. Restorative proctocolectomy with various types of reservoir. World J Surg. 1987 Dec;11(6):751–762. doi: 10.1007/BF01656598. [DOI] [PubMed] [Google Scholar]
  22. Parks A. G., Nicholls R. J., Belliveau P. Proctocolectomy with ileal reservoir and anal anastomosis. Br J Surg. 1980 Aug;67(8):533–538. doi: 10.1002/bjs.1800670802. [DOI] [PubMed] [Google Scholar]
  23. Pemberton J. H., Kelly K. A., Beart R. W., Jr, Dozois R. R., Wolff B. G., Ilstrup D. M. Ileal pouch-anal anastomosis for chronic ulcerative colitis. Long-term results. Ann Surg. 1987 Oct;206(4):504–513. doi: 10.1097/00000658-198710000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Polley T. Z., Jr, Coran A. G., Wesley J. R. A ten-year experience with ninety-two cases of Hirschsprung's disease. Including sixty-seven consecutive endorectal pull-through procedures. Ann Surg. 1985 Sep;202(3):349–355. doi: 10.1097/00000658-198509000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Schoetz D. J., Jr, Coller J. A., Veidenheimer M. C. Ileoanal reservoir for ulcerative colitis and familial polyposis. Arch Surg. 1986 Apr;121(4):404–409. doi: 10.1001/archsurg.1986.01400040040005. [DOI] [PubMed] [Google Scholar]
  26. Skarsgard E. D., Atkinson K. G., Bell G. A., Pezim M. E., Seal A. M., Sharp F. R. Function and quality of life results after ileal pouch surgery for chronic ulcerative colitis and familial polyposis. Am J Surg. 1989 May;157(5):467–471. doi: 10.1016/0002-9610(89)90636-3. [DOI] [PubMed] [Google Scholar]
  27. Stoller D. K., Coran A. G., Drongowski R. A., Bank E. R., Abrams G. D. Physiologic assessment of the four commonly performed endorectal pullthroughs. Ann Surg. 1987 Nov;206(5):586–594. doi: 10.1097/00000658-198711000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Taylor B. M., Beart R. W., Jr, Dozois R. R., Kelly K. A., Wolff B. G., Ilstrup D. M. The endorectal ileal pouch-anal anastomosis. Current clinical results. Dis Colon Rectum. 1984 Jun;27(6):347–350. doi: 10.1007/BF02552994. [DOI] [PubMed] [Google Scholar]
  29. Utsunomiya J., Iwama T., Imajo M., Matsuo S., Sawai S., Yaegashi K., Hirayama R. Total colectomy, mucosal proctectomy, and ileoanal anastomosis. Dis Colon Rectum. 1980 Oct;23(7):459–466. doi: 10.1007/BF02987076. [DOI] [PubMed] [Google Scholar]
  30. Vasilevsky C. A., Rothenberger D. A., Goldberg S. M. The S ileal pouch-anal anastomosis. World J Surg. 1987 Dec;11(6):742–750. doi: 10.1007/BF01656597. [DOI] [PubMed] [Google Scholar]
  31. Wong W. D., Rothenberger D. A., Goldberg S. M. Ileoanal pouch procedures. Curr Probl Surg. 1985 Mar;22(3):1–78. doi: 10.1016/0011-3840(85)90017-6. [DOI] [PubMed] [Google Scholar]

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