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October 26, 1984


JAMA. 1984;252(16):2229-2232. doi:10.1001/jama.1984.03350160097028

Removal of the rectum and anus for a benign, chronic, or even for a life-threatening disease such as malignancy has always been repugnant to patients and surgeons. Ileostomies or colostomies, although lifesaving, create problems and detract from an optimal quality of life. Attempts to improve ostomy function by continent ileostomies such as the Kocks pouch also produce problems, particularly "pouchitis," with inflammation, partial obstruction, stasis, and steatorrhea with abnormalities of calcium metabolism. Enterostomal therapy has made the life of a patient with an ostomy easier but still less than satisfactory. The goal of preservation of the anus has been a recent major advance, and a number of approaches and methods have been used. These include better methods of low anterior resection for carcinoma of the colon, local excision and/or radiation by implantation for certain rectal cancers, and anorectal pullthrough procedures. These have all increased the possibility of adequate treatment of