The endorectal pull-through for the management of familial polyposis

The standard surgical approach to multiple polyposis has been a total proctocolectomy and an end ileostomy because of the premalignant nature of the disease. This operation has been successful, but has resulted in a significant amount of psychological trauma due to the presence of an abdominal stoma. For that reason, we have utilized the sphincter-saving operation, namely, the endorectal pull-through for the definitive management of patients with familial polyposis since 1979. During the years 1979 to 1984, seven patients (4 female and 3 male), ranging in age from 10 to 30 years, have undergone an endorectal pull-through at our institution. Four of these patients had previously undergone a subtotal colectomy and ileoproctostomy and were seen because of persistent polyps in the remaining rectum. The operation consisted of a total colectomy, a mucosal proctectomy, an ileoanostomy and a loop ileostomy (1 patient did not undergo a loop ileostomy). The loop ileostomy was closed about two months after the pull-through procedure. There was no mortality and only one complication was seen postoperatively. This complication consisted of a bowel obstruction one week after ileostomy closure which was successfully treated with an enterolysis. Patient satisfaction has been excellent. All patients have either returned to full-time work or full-time school activity. All were completely continent immediately after ileostomy closure, both during the day and at night. The median stool frequency one year after the operation is five stools per 24 hours. Our results with this operation have encouraged us to recommend the endorectal pull-through to all patients with multiple polyposis.