Endorectal ileal pullthrough with lateral ileal reservoir for benign colorectal disease

Eight patients with ulcerative colitis and one with multiple polyposis have undergone total colectomy, mucosal proctectomy, endorectal ileal pullthrough with ileoanal anastomosis, and a diverting ileostomy at UCLA Hospital during a two-year period. Five of the patients underwent construction of side-to-side ileal reservoirs and closure of the cutaneous ileostomies within six months. Wound complications were uncommon compared with the previous clinical experience with an S-shaped ileal reservoir. Each of the five patients has complete fecal continence with an average of four bowel movements per 24-hour period. A temporary diverting ileostomy and transcutaneous reservoir catheter for irrigation help to minimize complications. Construction of an ileal reservoir proximal to the endorectal ileal pullthrough segment provides a better opportunity for fecal storage than if no reservoir is used because it reduces defecatory urgency and frequency as well as perineal inflammation. The lateral ileal reservoir produces less stasis and achieves a more regular defecatory pattern than the S-shaped reservoir. Favorable clinical experience with the lateral internal ileal reservoir and ileoanal anastomosis in five patients who had ulcerative colitis or multiple polyposis suggests that further clinical application in selected patients is warranted.