Significance of reservoir length in the endorectal ileal pullthrough with ileal reservoir.

Ileal reservoirs have been used almost routinely in conjunction with total colectomy and the endorectal ileal pullthrough procedure for ulcerative colitis and familial polyposis. Of 153 patients who underwent surgery at UCLA Medical Center during the past seven years, a comparison was made between 14 patients with an initial reservoir length of greater than 30 cm (large) and 54 patients with a short reservoir (14 to 20 cm). Although patients with long reservoirs had a low stool frequency in the first postoperative year, there was a subsequent increase. During the first two postoperative years, six (43%) of 14 patients developed reservoir enlargement with secondary pouchitis and diarrhea, which severely limited their activities, finally requiring partial resection. Only one of the 14 patients with short reservoirs who underwent surgery more than two years previously had a resection. Complications requiring operative treatment were more than five times greater in patients with long reservoirs. All patients with shortened reservoirs experienced dramatic improvement in their clinical course within one month. Ileal reservoirs of 14 to 16 cm in length appear to provide long-term, excellent clinical function, with an incidence of pouchitis of less than 5%. Symptoms in patients with large reservoirs may be greatly improved by reservoir shortening.