The popular view of ileorectal anastomosis for ulcerative colitis as an operation of above average mortality and morbidity is supported by the results of this series. Great care must be taken to differentiate ulcerative colitis from Crohn's disease of the colon, as it is clear from consideration of their clinical course that they are different disease entities with a different prognosis.
It is suggested that the more general adoption of Aylett's operative technique would reduce the number of failures due to sepsis. There appears to be a group of patients, 15% in this series, who will be failures because of intractable diarrhoea despite a technically adequate and successful operation, but it might be possible to reduce these with modern medical therapy given postoperatively.
Patients with a preoperative history of more than 10 years' disease appear to do better than the others. An actively diseased rectum does not appear adversely to affect the result, and the fulminating disease is not a counter indication to a staged ileorectal anastomosis. The use of steroids preoperatively does not appear to affect the healing of the anastomosis or the longterm result of the operation.
No case of carcinoma of the rectum has occurred in this series but there has been histological evidence of premalignant change in two patients. The need for a strict follow-up programme, including regular sigmoidoscopy and rectal biopsy, is emphasized.
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