Experience with mucosal proctectomy and a J-shaped ileal reservoir in ulcerative colitis.

Total colectomy, mucosal proctectomy and ileal pouch formation has been carried out in 18 patients over a 4 year period. The rectum was divided 5 cm above the anorectal junction and a J-shaped ileal pouch was formed with a 15 cm limb. Two patients had an initial colectomy for toxic dilatation of the colon and mucosal proctectomy with pouch formation was carried out at a later date. All patients had a loop ileostomy for 4 months. The operation failed in 3 patients due to incontinence in 2 and fistula formation in one. The postoperative frequency of defaecation was 4.3 +/- 0.7/day. When offered the choice of sphincter saving surgery or proctocolectomy with ileostomy over 90% of colitis choose the former which produced good results (modified Visick grades I and II) in 73% in the present series.