Preservation of ileocecal junction and entire anal canal in surgery for ulcerative colitis--a "two-sphincter" operation

Abstract

Disruption of the terminal ileum and excision of the ileocecal junction during restorative proctocolectomy and formation of a pelvic ileal reservoir may lead to abnormalities of motility, transit, and absorption. We therefore preserved this portion of the gastrointestinal tract in 12 patients who underwent restorative proctocolectomy for ulcerative colitis. In each patient, the entire anal sphincter was preserved without mucosal stripping: the two sphincters were connected by a single loop of ileum without any reservoir. After median follow-up of 12 months, the functional results were similar to those seen with conventional pelvic ileal reservoirs and superior to the results of mucosal proctectomy and straight endoanal ileoanal anastomosis. This operation may be an alternative to standard restorative proctocolectomy for patients with ulcerative colitis.