Many operative procedures that were too new to evaluate in the 1970s are now, after having been tried for a decade, accepted as state-of-the-art in surgery. At the same time, great strides have been made in the standardization of various physiological studies of the anorectum. Many of these are now routinely performed in patients with intractable constipation, anal incontinence, and pelvic-floor abnormalities.
In surgery of chronic ulcerative colitis and familial polyposis coli, total abdominal colectomy, mucosal proctectomy, and ileal pouch—anal anastomosis have effectively replaced total proctocolectomy and permanent ileostomy. Almost all patients have a temporary ileostomy for only three months after this major operation. Patients invariably prefer the physiological result of this operation. Early complications such as sepsis occur in 10% of patients and pouch ileitis occurs in another 7%.1 Ninety-five percent of patients are continent of stool and gas, and soilage is seen in only 5% of patients.