Introduction

Over the second half of the last century, proctocolectomy in regards to terminal ileostomy has played an important role in the management of inflammatory diseases affecting the colon and rectum. For a long time it has been considered the gold-standard operation and all the results of alternative procedures have been compared with it. Before the era of restorative proctocolectomy, the possibility of removing all the diseased tissue in a one-stage procedure while avoiding the risk of cancer made this technique very successful. However, although this procedure has a low rate of morbidity and mortality and allows the patients an early return to normal activities [1], there are some important drawbacks that have spurred surgeons on to develop restorative proctocolectomy. First of all, the patients perceive the ileostomy as an unnatural condition which impairs their relationships and social life. Although modern stoma care allows an easier management of the stoma appliance, the unpredictable faecal and noisy gaseous discharge may be of such an extent that they restrict patient activities to the point of becoming a psychological barrier. Sexual complaints of the patients depend on both the functional and psychological impairment. Permanent impotence is rare with the intersphinteric technique and some authors have reported no permanent male dysfunction, either partial or complete, when using a perimuscular rectal excision during the proctocolectomy [2]. Women often complain of vaginal discharge and dyspareunia because of the per-ineal scar. However, psychological lability and the perception of the self-image are the factors that mainly affect sexual intercourse and the relationship of the patient. Moreover, some bladder dysfunctions may occur [3] and the perineal wound healing may take a long time, particularly in patients with undetected Crohn's disease [4]. Finally, the cost of the management of the ileostomy should be considered.

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