ABSTRACT
Restorative proctocolectomy, also known as ileal pouchanal anastomosis (IPAA), is suitable for diffuse mucosal diseases of the large bowel, such as ulcerative colitis and familial adenomatous polyposis. The mortality of the former was 50 percent up to the introduction of colectomy with ileostomy in the late 1930s and 1940s, when it fell precipitously to under 5 percent. The resulting stoma was usually well accepted by patients in exchange for the recovery of health. Attempts to avoid a permanent stoma were, however, made from the early 1940s. Colectomy with ileorectal anastomosis left the rectum, which in many colitic patients led to continued poor function and also the risk of malignant transformation. This operation has largely been replaced by restorative proctocolectomy, originally described by Nissen in 1934 and subsequently developed by Ravitch, Bacon, Kock, and Parks. The present form of the operation resembles that described by Parks (1978) with subsequent modifications of the type of ileal reservoir used and the method of performing theileoanal anastomosis. Restorative proctocolectomy is now the most frequentlyused operation when surgery is indicated in ulcerative colitis.
