Current status of sphincter-saving operations for chronic ulcerative colitis.

When surgery is demanded by the course of a patient with ulcerative colitis, the sphincter mechanism can be spared. The straight ileoanal anastomosis without a reservoir has not been satisfactory for adults because of frequent diarrheal stools. The ileorectal anastomosis has the advantage of minimal morbidity, but the patient is not totally cured, because the diseased rectum is still in place. The pouch pull-through procedure has an increased morbidity, but the patient is cured of ulcerative colitis. The anastomotic stricture rate is 7% to 15% and the failure rate, 2% to 6%. Inflammation of the pouch or reservoir occurs in 5% to 19%. There have been no deaths in the reviewed series. As the details of the pouch pull-through procedure are refined, this operation will become the choice for treatment of ulcerative colitis.