Satoshi Matsuo

Total colectomy, mucosal proctectomy, and ileoanal anastomosis

A safe and practical procedure for total colectomy and mucosal proctectomy with ileonal anastomosis has been developed and performed by us on 11 patients with adenomatosis coli and two patients with ulcerative colitis. The major features of the operative procedure are 1) total removal of the rectal mucosa to just above the dentate line; 2) preservation of anorectal function by a long rectal cuff procedure achieved by rectal mucosal excision from a level just below the sacral promontory, using a rectal internal stent and gauze packing techniques for rectal mucosal stripping, with, in some patients, an ileal reservoir added; and 3) prevention of pelvic sepsis by intraoperative rectal irrigation, rectal cuff drainage, and a temporary defunctioning loop ileostomy. Of six patients with at least three months of follow-up after reconstruction, each has returned to normal life, averaging two to seven semiformed stools each day. A side-to-end ileoanal anastomosis with a lowlying, loop-type ileal reservoir provided the best functional results.

Histology of the healing process after total colectomy, mucosal proctectomy and ileo-anostomy

Total colectomy, mucosal proctectomy and ileo-anostomy were performed on 10 dogs to observe the healing process of the space between the rectal muscle cuff and the pulled through ileum. Adhesion was complete in six cases. The ileal and rectal muscle layers were well preserved, but two weeks after the surgery the healing was not completed. One month after the operation, there was little scar formation between the rectal muscle cuff and the ileum, in the absence of infection. If there was infection between the ileum and the rectal muscle cuff, abscess and scar formation was seen even one month after the operation. This operation is thought to be rational from a histological viewpoint and the most important factor is the prevention of infection in the space between the ileum and rectal muscle cuff.