[Development of ileal J-pouch anal anastomosis]

The practical procedures of ileoanal anastomosis (IAA) has developed through the two independent lines of thinking. The one idea involved pooling of the intestinal content in an ileal reservoir as S-shaped pelvic pouch by Parks. The other was the concept of rectal mucosal replacement by Peck who grafted a ileal mucosal segment within the totally denuded preserved rectal cuff. The author followed on the later concept and constructed an laterally anastomosed antiperistaltic looped ileum with which the pouch was able to joint directly to the anus in a side to end fashion to form a structure similar to the natural rectal ampulla and always spontaneously evacuable. Currently most of the surgeons in the world who perform IAA use the technique of the J pouch and in the present department, IAA has been performed on 150 patients with UC and 120 with FAP during the last 13 years and the number of these patients is ever increasing. These evidences suggest the operation that has been established is the superior above the other alternative techniques of proctocolectomy.