Ileorectal Anastomosis for Ulcerative Colitis: Prevention of Relapses and Neoplasia of the Rectal Stump with Topical Treatment

Abstract

We studied the effect of topical treatment with sulfasalazine and corticosteroids on the fate of the rectal stump after ileorectal anastomosis (IRA) for ulcerative colitis. From 1972 to 1986, 31 patients with ulcerative colitis underwent colectomy and IRA. Macroscopically, 93.5% of them had only minor involvement of the rectal mucosa; microscopically, mild or moderate inflammation. Only 2 patients had low-grade dysplasia before surgery. Postoperatively, all patients had a continuous topical treatment with sulfasalazine and corticosteroids. They were monitored carefully for relapses, development of dysplasia and cancer in the rectal stump by endoscopy and histological examination. No proctectomy was performed 1–15 years after the operation; only 29% of the patients had flare-ups of ulcerative colitis in the rectum and 2 patients developed precancerous lesions, and the 2 patients who had preoperative dysplasia have no dysplasia at present. Therefore, we think that topical treatment with sulfasalazine and steroids is useful to improve the results of IRA for ulcerative colitis.