Total colectomy until recently has meant a permanent ileostomy. However, several authors* have recommended preservation of the terminal rectum, which is then fulgurated of polyps or stripped of the mucosa in the area accessible to a sigmoidoscope, thus permitting ileosigmoidostomy. Such a procedure is intended to save the terminal rectum and yet prevent the subsequent development of malignant disease therein.
In 1947, Ravitch and Sabiston6 described a one-stage surgical procedure in dogs for accomplishing an anal ileostomy, which they thought might be feasible in man with some modification. Procedures of this type have since been applied to patients with either ulcerative colitis or polypoid adenomatosis by Ravitch and co-workers,† Wangensteen and Toom,‡ Best,§ and Devine and Webb.14 A summary of the 29 cases of these investigators as tabulated by Best in 195213 shows satisfactory results in about half of the patients with ulcerative colitis and in less