RT Book, Section A1 Ellison, E. Christopher A1 Zollinger, Jr., Robert M. A1 Pawlik, Timothy M. A1 Vaccaro, Patrick S. A1 Bitans, Marita A1 Baker, Anthony S. SR Print(0) ID 1187821942 T1 Ileoanal Anastomosis T2 Zollinger’s Atlas of Surgical Operations, 11e YR 2022 FD 2022 PB McGraw-Hill Education PP New York, NY SN 9781260440850 LK accesssurgery.mhmedical.com/content.aspx?aid=1187821942 RD 2024/11/09 AB A permanent ileostomy following removal of the colon can be avoided in selected patients by removing all diseased colon and rectum down to the top of the columns of Morgagni or the pectinate line, followed by construction of an ileal reservoir, with anastomosis of the anal canal (FIGURE 1). Patients with ulcerative colitis (UC) and polyposis are candidates for this procedure, but those with Crohn’s disease are generally not because of the potential for involvement of the small intestine. The patient must have an adequate anal sphincter by digital examination or, better yet, by manometry. The rectum should be free of ulcerations, abscesses, stricture, fissures, or fistulas. This is especially important in patients with UC. This procedure can be considered in patients who are strongly opposed to an ileostomy and who are available for prolonged close follow-up. The patient should thoroughly understand the uncertainties of postoperative anal control and the need to have patience during the early months after the operation. The procedure is not recommended for frail, elderly patients and those who have fecal incontinence. Obesity may make it impossible to perform the anal pouch anastomosis. In patients with familial adenomatous polyposis, desmoid tumors involving the small bowel mesentery can make it difficult to obtain adequate length to reach the anus with the pouch. All patients should realize that a permanent ileostomy sometimes can be required because of factors not known until the procedure is underway.