To the Editor. —The article by Fonkalsrud et al1 in the September 1988 issue of the Archives1 presents the progression of technical improvements in endorectal ileal pullthrough with better end results. The operation can still present problems. The terminal ileum has specific absorptive capability and mechanism to slow the intestinal stream.2 It would be interesting to have noted how much of the terminal ileum is retained. The distal ileal 4 cm is a zone of elevated pressure. Its resting pressure is 20 mm Hg greater than colonic pressure.3 It does not permit reflux, even with distal obstruction to the point of cecal rupture. Bacterial colonization proximal to the junction is rare. This may be an important factor in preventing reflux enteritis, especially in an ileal reservoir.
The ileal mucosa extends to 1 cm of the apex of the protuberance, and a transitional mucosa extends to the
BRASLOW L. Endorectal Ileal Pullthrough. Arch Surg. 1989;124(4):508. doi:10.1001/archsurg.1989.01410040118028