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 2024/04/19
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.