[Studies on total colectomy, mucosal proctectomy and ileoanal anastomosis (ileoanostomy)]

Studies have been made in order to establish a practical operative procedure of the ileoanostomy as well as to understand its postoperative pathophysiology using 45 patients including 34 with familial polyposis and 11 with ulcerative colitis those which have been followed up for 1 to 4 years. Three major technical problems here with challenged are how to minimize the complications, how to improve the bowel function and how to simplify the procedure. Our J-pouch method was found to have better bowel function compared with those without a pouch and those with H-pouch and also considered to be superior to S-pouch, with its consistent spontaneous evacuation and with a simpler construction. The length of rectal cuff was found to be able to be minimized down to just above the levator muscle without disturbing the bowel function, based on our experiences on two polyposis cases with rectal cancers. The short rectal cuff of about 7-6 cm was considered to be the method of choice for eliminating the cuff abscess in addition to routine use of a diverting ileostomy, and for technical simplification. Ano-abdominal rectal mucosectomy at prone-jack-knife position is recommended to achieve further technical feasibility. The pathophysiological studies including anorectal manometry, intestinal transit time, physical, chemical and bacteriological analysis of the stool, water absorption of the ileal neorectum as well as the systemic metabolic studies supported favorable clinical result of our method. Ileoanostomy by our principle consisting of J-pouch, short cuff and loop-ileostomy, was concluded to be a break through to avoid an abdominal ileostomy after total proctocolectomy.