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Minimizing the impact of intestinal surgery

Phil Gunby
JAMA. 1981;245(1):14. doi:10.1001/jama.1981.03310260008003.
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Efforts are increasing to make life as normal as possible for patients who require surgical removal of diseased portions,of the alimentary tract. Studies on ileoanal anastomosis and ileostomy occluding devices are under way at the Mayo Clinic and elsewhere.

At Mayo, a "resurrected technique" used in the 1940s in Europe and the United States is now being used for some patients. Colonic disease limited to the mucosa is treated by colectomy, mucosal proctectomy, and endorectal-ileal pull-through with preservation of the anal sphincter (Surg Gynecol Obstet 1947;84:1095-1099).

Surgical resident Jacques Heppell, MD, who under a Canadian Medical Research Council grant is working with Keith A. Kelly, MD, explains that continence is related not only to good sphincter function but also to the reservoir capacity of the rectum. The hypothesis is that, after such surgery, the terminal ileum can dilate secondary to chronic intermittent occlusion by sphincter contraction. The sphincter pressure that


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