Status of the endorectal ileal pullthrough procedure for ulcerative colitis and polyposis

Since 1977, 174 patients with ulcerative colitis and 16 with polyposis underwent colectomy with endorectal ileal pullthrough in two stages with a temporary ileostomy. Five had an S, three a J, and 15 had no reservoir (NR); 97 had a lateral reservoir (LR) constructed at the second, and 70 at the first operation. Ten patients with NR and one with JR were converted to LR because of unacceptable stool frequency. Three patients with SR and seven of 178 LR patients (3.9 per cent) returned to a permanent ileostomy or Kock pouch. More than 65 per cent of complications occurred in the first 50 patients. Late reservoir shortening was necessary in 36 patients. Of the last 115 patients, 112 are functioning well with a mean of six bowel movements per 24 hours. The endorectal ileal pullthrough with reservoir provides a good option to the standard proctocolectomy for patients with ulcerative colitis or polyposis. In our experience, a short rectal muscle cuff (less than 5 cm), removal of all rectal mucosa to the dentate line, and construction of a short LR (less than 15 cm) at the first operation produces the fewest complications and the best results. The majority of complications, including pouchitis, can be either avoided or corrected surgically.