A reappraisal of the ileo-rectal anastomosis in ulcerative colitis

Pär Myrelid, Tom Øresland

Colectomy is still frequently required in the care of ulcerative colitis. The most common indications are either non-responding colitis in the emergency setting, chronic active disease, steroid-dependent disease or neoplastic change like dysplasia or cancer. The use of the ileal pouch anal anastomosis has internationally been the gold standard substituting the rectum with a pouch. Recently the use of the ileorectal anastomosis has increased in frequency as reconstructive method after subtotal colectomy. Data from centers using ileorectal anastomosis has shown the method to be safe with a function and risk of failure comparable with the ileal pouch anal anastomosis. The methods have different advantages as well as disadvantages depending on a number of patient factors and were in life the patient is at time of reconstruction. The ileorectal anastomosis could, together with the Kock continent ileostomy, in selected cases be a complement to the ileal pouch anal anastomosis in ulcerative colitis and should be discussed with the patient prior to the decision of reconstructive method.