<Original Articles>Posterior Proctomucosectomy and Ileal Pullthrough Reconstruction : A New Restorative Procedure after Total Proctocolectomy

Abstract

We reported a new method of restorative proctocolectomy using posterior approach and pull through reconstruction. This method obviated transanal manipulation, a major factor causing damage to the internal sphincter, thus preventing fecal incontinence due to sphincter dysfunction. Also, temporary ileostomy was not necessary becaasue the spout of an S-pouch was pulled down below the anal verge and its distal free end acted as a diverting stoma while the more proximal, healing zone (future anastomotic line) was kept from fecal contamination. This method was applied to a 32-year-old woman with familial polyposis coli and a 50 year old woman with ulcerative colitis. Their bowel movements steadily decreased to three times and five times a day, respectively. There was no fecal leakage or perianal excoriation. The advantages as well as disadvantages of this method compared with the conventional techniques were discussed.

後方からの直腸到達法と貫通術式による新しい大腸全摘再建法を報告した. 本法は内肛門括約筋損傷の主因である経肛門操作を必要とせず, 括約筋障害による便失禁を予防できる. またS型貯留嚢の下方遊離断端が肛門外に引き出されて人工肛門の役割を果たし, 口側の回腸肛門癒合帯(将来の吻合線)の便汚染を防ぐために, 一時的回腸瘻造設も不必要である. 本法を32歳の家族性結腸腺腫症の女性と50歳の潰瘍性大腸炎の女性に施行した. 術後便回数は着実に減少し各々1日3回と5回となった. また肛門からの便漏れや皮膚びらんも認めなかった. 本法の利点や欠点を他の方法と比較検討した.