Ileorectal anastomosis for ulcerative colitis.

Several options can be considered when medical management of ulcerative colitis fails or if a serious complication develops. One alternative to proctocolectomy with ileostomy or ileoanal pull-through is the ileorectal anastomosis. Its main advantage is preservation of the rectal reservoir without risking injury to the pelvic nerves or and sphincter. It is not indicated when the rectum is severely diseased or stenosed or in the presence of rectal carcinoma. Patients older than 55 to 60 years can expect a good functional result in a relatively short time compared with the prolonged adaptation period associated with pull-through procedures.