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Response to ileorectal anastomoses

We thank Dr Church for his interest in our paper. We are glad this has generated discussion and are very grateful for his input. In general, we agree with the principles outlined, in particular emphasizing blood supply and preserving normal anatomy as much as possible to achieve optimal patient outcome. Regarding the point on side-to-side anastomosis, however, we tend to concur with the findings of Chen et al. which demonstrated improved short-term faecal continence compared with a straight anastomosis, potentially due to the larger reservoir created. The comments highlight that there are a lot of subtleties and variations in ileorectal and ileosigmoid anastomotic techniques, with limited evidence to guide practice. Our purpose was to reinforce general principles and outline options available to surgeons in one succinct document. The particular techniques we describe are in routine use at our institution with favourable outcomes, and we hope the descriptions will be helpful to others.