Staging of the endorectal pull-through operation for ulcerative colitis.

Of 43 patients undergoing operation for ulcerative colitis or polyposis, we found staging of the operation advisable in 7 instances. The initial operation consisted of subtotal colectomy with a Hartman's pouch and an ileostomy. The second procedure was a mucosal proctectomy, ileoanal anastomosis, and construction of a pelvic reservoir into the terminal ileum. The ileostomy was closed as a third procedure with approximately 6 months between each operation. Staging is recommended when emergency operation is required because of bleeding, perforation, or toxic megacolon; when significant technical problems are encountered with the mucosal stripping; or when the surgeon has had limited experience with the procedure. With the addition of staging to the surgeon's armamentarium, it is now possible to offer total colectomy with preservation of rectal continence to virtually all patients suffering from chronic ulcerative colitis.