ABSTRACT
This chapter shows the possible advantages and disadvantages of an ileorectal anastomosis in ulcerative colitis. Some centres and some nations have returned to the use of ileorectal anastomosis as an alternative to ileal pouch anal anastomosis. Topical anti-inflammatory medication with mesalazine together with meticulous endoscopic surveillance has led to the reintroduction of the ileorectal anastomosis in some parts of the world, especially Sweden. A laparoscopic approach is the standard procedure when doing both a primary ileorectal anastomosis at the time of the colectomy as well for reconstruction after a previous subtotal colectomy. Ileorectal anastomosis is a lesser procedure compared with an ileal pouch anal anastomosis, involving a shorter operating time and less blood loss. The risk of rectal cancer was one of the reasons why ileorectal anastomosis was abandoned in ulcerative colitis. A trial to compare ileorectal anastomosis with ileal pouch anal anastomosis as primary treatment failed to recruit, because patients had different expectations of each after appropriate counselling.
