A review of twenty-one rectal mucosectomy and ileal pouch pull through procedures.

Twenty-one patients with chronic ulcerative colitis (CUC) or familial polyposis underwent total colectomy, rectal mucosectomy, ileal pouch formation and anastomosis of the pouch to the dentate line. Eleven (52%) intraoperative problems occurred. No deaths resulted. Ten (48%) postoperative complications were treated without operative intervention. Ten postoperative complications required a minor or major procedure to remedy the problem. The most common major complications were four small bowel obstructions. The only septic complication was a single wound infection. Functional results have been satisfactory with 14 of 19 (74%) having six or fewer bowel movements per day. Most patients do not wear perineal pads either day or night. Only one patient felt his lifestyle had worsened. Seventeen of 19 (90%) patients were satisfied with their result and would choose to have the operation again. Frequent diarrheal stools associated with incontinence was the primary reason for a failure and excision of one pouch. This procedure is becoming the alternative of choice for CUC and polyposis because of the ability to cure the disease as well as preserve anal sphincter function.