Ileorectal anastomosis--friend or foe?

Ileorectal anastomosis is a controversial operation. Its use has been promoted for the management of colonic cancer, familial polyposis, Crohn's disease, ulcerative colitis and in several rarer conditions. In the treatment of ulcerative colitis controversy has centered on the risk of malignant change in the retained rectum and on the long term quality of function. E. S. R. Hughes has been a proponent of this procedure and is one of those able to report a major series with long term follow-up of function and cancer development in ulcerative colitis. Of 364 colitics treated by resection, 43% were selected for this operation. This group showed a success rate of 72% and after 15 years 57% remained functional. The probability of malignant change has reached 14% at 27 years with 8% of the series developing rectal carcinoma. The probability of this development following a diagnosis of moderate or severe mucosal dysplasia reached 42% at 13 years from histological assessment. Ileorectal anastomosis has a high degree of acceptability in appropriately selected ulcerative colitics; its continuing use is dependent on surveillance of sufficient quality to predict cancerous change or to detect it earlier enough to effect cure by proctectomy.