Ileorectal anastomosis in the surgical treatment of ulcerative colitis: long-term results

Total colectomy with ileorectal anastomosis (IRA) is an alternative to the ileoanal pouch for the surgical treatment of ulcerative colitis in a selected group of patients. This technique leaves rectal mucosa liable to develop persistent proctitis, dysplasia and cancer. To describe short and long-term results of IRA and to assess the presence of dysplasia. Descriptive study of patients treated with IRA. The data were obtained from the clinical records, and the present status was evaluated with an interview. A proctoscopy and biopsy was offered free of cost to the contacted patients. Between 1978 and 2005, 26 patients were operated. One patient presented an anastomotic leakage that was treated with a loop ileostomy. There was no operative mortality. Twenty-three patients were followed for a period of 1 to 23 years. Three patients evolved as Crohn 's disease and two of them needed a proctectomy. Three patients died of non-related diseases. In the remaining 17, the average evacuation rate was 3.7/24 h and all were continent. None developed a rectal cancer Only two patients had their planned annual endoscopic surveillance. In 2 of the 11 patients who accepted endoscopy and biopsy, a low-grade dysplasia was found. IRA has low morbidity and acceptable functional results in this selected group of patients. No patient presents high-grade dysplasia or cancer; however, the adherence to the endoscopic follow-up is poor.