The treatment of choice for ulcerative colitis (UC) and familial adenomatous polyposis (FAP) has been the ileoanal anastomosis with ileal reservoir following total rectocolectomy. This procedure has been used since 1983 and the purpose of this study is to review the results of this series and to analyse the controversial points related to the procedure. Seventy- three patients - mean age 34.6 (13-63) years,female 42 patients (56,7%) - were submitted to the procedure to treat UC (46 patients - 63.0%) and FAP (27% -37,0%). The techniques utilized were: large S and long efferent limb (eight); short S and short efferent limb; "two-chamber”(20); J (23). All the procedures performed were protected by loop ileostomy. Since 1993, all colectomy is performed preserving the right colon marginal vascular arcade. Seventy patients have at least one year of postoperative time and 61 have two years or more (mean 7.01 (1-16) years) Early complications were considered when present until the 30th postoperative day and late complications when diagnosed after this time. Functional results were analysed after the first postoperative year following ileostomy closure. Thirty-five early complications occurred for 22 patients and 39 late complications, for 35 patients. Twenty-five patients did not have any complication related to the procedure. The most frequent complications were: intestinal obstruction (19.1%); fistulization (cutaneous, vaginal, or urinary tract) (10.9%), reservoir ischemia (partial or total)(9.5%), and pouchitis (6.8%). Nine patients (12.3%) have working ileostomy: seven with defunctioned reservoir kept in place and two after reservoir excision). Mortality related to the procedure occurred for two patients, however four others died lately by general causes as malnutrition and tumor of the cerebellum. Functional results were analysed in 58 patients and good day and night continence were present for the majority of the patients (95.0% and 90.0%, respectively). Mean daily bowel movements were: min 4.1 and max 5.7 (ranging 1 - 12); mean nightly bowel movements were: min 0.4 and max 1.2 (ranging O - 4). In conclusion, in spite of the morbidity and remaining controversial points, long term fuctional results has lead good expectation with the procedure and has encouraged its indication.
Ileoanal anastomosis; Ileal reservoir; Ileal pouch; Ileal pouch-anal anastomosis; Ulcerative colitis; familial adenomatous polyposis