Pouch-anal anastomosis without diverting ileostomy

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 GIA90 (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.