Endorectal ileal pullthrough with ileal reservoir for ulcerative colitis and polyposis

Total colectomy, mucosal proctectomy, and endorectal ileal pullthrough operations were performed in 29 patients (mean age 16.8 years) with ulcerative colitis or polyposis during the past 10 years. The immediate and long-term results achieved after use of a lateral internal ileal reservoir 25 to 30 cm long in 15 patients were superior to those after construction of an S-shaped reservoir (5 patients) or when no ileal reservoir was used (3 patients). A completely diverting ileostomy was used for approximately 4 months to minimize complications. A mean of four continent bowel movements per 24 hours has been achieved within 4 weeks in patients with lateral reservoirs; all have returned to school or work within 4.5 weeks. The absence of mortality and the low morbidity suggest that the endorectal pullthrough with ileal reservoir should be the primary operation early in the course of ulcerative colitis refractory to medical therapy.