Ileorectostomy in the older patient

Surgeons have always been wary of performing abdominal colectomy and ileorectostomy in the older patient for fear of excessive stool frequency and fecal incontinence. Thirty-two patients, aged 60 years or over, underwent abdominal colectomy and ileorectostomy and were closely questioned regarding their preoperative, early postoperative, and late postoperative bowel habits. These patients were compared with a group of age- and sex-matched controls who had undergone right hemicolectomy. In both groups, the ileocecal valve had been resected, but only the ileorectostomy group had the entire colon resected. Immediately after ileorectostomy, patients underwent an average increase in bowel movements of 3.6 movements per day. This gradually decreased over time, so that, after five years, older patients with ileorectostomy had an average of 1.5 more bowel movements per day than they had had preoperatively. There were similar increases in the right hemicolectomy patient group: 0.9 bowel movements per day immediately after right hemicolectomy and 0.2 bowel movements per day after five years. Incontinence was an uncommon problem in both groups. This study suggests that elderly patients undergoing abdominal colectomy and ileorectostomy have an increase in daily bowel movements, which is not solely attributable to the loss of the right colon. However, it is a procedure that is well tolerated, with a low risk of incontinence and only a mild increase in stool frequency.