Ultrasonic mucosal proctectomy without endorectal pull-through.

The surgical treatment of patients with familial polyposis coli and ulcerative colitis often requires removal of the rectum. Abdominoperineal resection, however, has a substantial morbidity. Ultrasonic fragmentation allows complete removal of the distal rectal mucosa with preservation of the surrounding muscularis. Ten adult mongrel dogs underwent ultrasonic mucosal proctectomy with resection of the proximal rectum and end colostomy. Two months later, the animals were sacrificed and the remaining rectum was removed and examined. The rectal remnant had shrunk and there was fibrous healing of the muscular wall with obliteration of the lumen. There was no mucosal regeneration. Ultrasonic mucosal proctectomy appears to achieve the same results as abdominoperineal resection of the rectum without the morbidity of the perineal dissection. This procedure may be useful in those patients where removal of the rectum is necessary for benign disease and endorectal pull-through is not indicated.