Alternatives to conventional ileostomy in chronic ulcerative colitis.

As long as surgeons have performed total proctocolectomy with permanent ileostomy, efforts have been made to avoid the necessity for a permanent stoma. Preservation of sphincter function can now be achieved by more liberal application of the operation of abdominal colectomy and ileorectal anastomosis in carefully selected patients, and knowledge of the progression from dysplasia to cancer can be applied in a prospective fashion to those persons potentially at risk who have retained rectal mucosa. Individuals who are incapable of dealing with conventional permanent ileostomy and who lack the potential use of their own sphincters can be offered the alternative of a continent ileostomy. The advantages of both of these procedures can be combined by greater application of the operation of total abdominal colectomy, mucosal proctectomy, and ileoanal reservoir with ileoanal anastomosis. Although enthusiasm exists for all of these procedures, their results should be compared with the results of what must still be considered the "gold standard" operation, that is, proctocolectomy and conventional ileostomy. Nevertheless, the alternative procedures represent a considerable advance in the overall care of patients with chronic ulcerative colitis.