Total colectomy and ileorectal anastomosis in ulcerative colitis

In an attempt to determine the best indications for the classically adopted ileo-rectal anastomosis (IRA) and the new techniques of restorative proctocolectomy, namely, ileal J-pouch-anal anastomosis (IAA) ilea J-pouch-anal canal anastomosis (IACA), we retrospectively studied 72 surgically treated patients with ulcerative colitis (UC) followed in our surgical department in the period between 1963 and 1994. Compared to these new techniques, IRA had a lower incidence of postoperative fecal incontinence, and was one-stepped in the majority of the patients. No significant difference regarding postoperative bowel function, operation time, volume of bleeding, hospital stay, and the need for postoperative prednisolone was observed. We concluded that IRA is a good procedure that is indicated for patients receiving high-dose prednisolone, for those who need a quick return to social activity, and for those with poor anal function. IACA is a good indication for those patients with good anal function assessed preoperatively, who agree to receive a multi-step operation. For those patients with cancer or dysplasia, IAA should be the operation of first choice.