Abstract
Ileoanal anastomosis (IAA) indicates total removal of the anorectal mucosa and anastomosis of the ileum to the anus at the level of the dentate line. The procedure for IAA that was developed in the Tokyo series (1979-1982) has been established in the Hyogo series (1983-1991) including 64 patients with colitis and 45 with polyposis. The current procedure involves medium cuff mucosectomy from the anoabdominal approach, direct anastomosis of J-ileal pouch to the anal sphincteric mechanism and routine use of defunctionning ileostomy. The three-staged program (mostly by the Schneider procedure) has been used in 75% of ulcerative colitis (UC) cases to perform IAA always in the optimum condition. With the above procedure and strategy, 88.2% or more of our UC patients were able to be relieved of the symptom without permanent ileostomy. Of our patients with IAA 66% had normal continence with daily stool frequency of 4.8 times on average. The procedure is now practical although it requires the experience and skill of a specialized surgeon. More studies are needed to achieve optimum function and for further reduction of postoperative complications and late sequellae such as pouchitis that was seen in 11%.
