Dis Colon Rectum  1980 Oct;23(7):459-66 

Total colectomy, mucosal proctectomy, and ileoanal anastomosis.

Utsunomiya J, Iwama T, Imajo M, Matsuo S, Sawai S, Yaegashi K, Hirayama R.

A safe and practical procedure for total colectomy and mucosal proctectomy with

ileoanal anastomosis has been developed and performed by us on 11 patients with

adenomatosis coli and two patients with ulcerative colitis. The major features

of the operative procedure are 1) total removal of the rectal mucosa to just

above the dentate line; 2) preservation of anorectal function by a long rectal

cuff procedure achieved by rectal mucosal excision from a level just below the

sacral promontory, using a rectal internal stent and gauze packing techniques

for rectal mucosal stripping, with, in some patients, an ileal reservoir added;

and 3) prevention of pelvic sepsis by intraoperative rectal irrigation, rectal

cuff drainage, and a temporary defunctioning loop ileostomy. Of six patients

with at least three months of follow-up after reconstruction, each has returned

to normal life, averaging two to seven semiformed stools each day. A side-to-end

ileoanal anastomosis with a low-lying, loop-type ileal reservoir provided the

best functional results.