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Abstract
Background. The purpose of the study was to review those features that we believed to be critical
to the successful performance of the ileal pouch-anal anastomosis, or pull-through,
procedure, and specifically the complication of pouchitis.
Methods. The charts of 205 patients who successfully underwent ileal pouch-anal anastomosis
procedure were reviewed. No follow-up was available in five patients; therefore the
basis of this report and its analysis was based on 200 consecutive procedures in which
at least two of the three surgeons participated. Particular emphasis was placed on
continence, particularly nighttime continence. The incidence of pouchitis, either
a single episode or intermittent episodes, was surveyed. Particular attention was
paid to the level of rectal mucosectomy and anastomosis at the top of the columns
of Morgagni, thus retaining the transitional zone.
Results. Only 5% of patients were incontinent in the absence of pouchitis. Twenty-five patients
(13%) wore a pad at night, but only nine (5%) wore a pad during the day. Of those
patients with pouchitis, 6% (12) have had a single episode and 12% (23) were intermittently
on medication. Therapy of pouchitis was usually carried out with ciprofloxacin 500
mg by mouth everyday or twice a day.
Conclusions. Ileal pouch-anal anastomosis is an excellent procedure, provided technical details
are adhered to. Satisfactory outcome with respect to nighttime continence can be achieved
with rectal mucosectomy with minimal manipulation and retaining the transitional epithelium,
performing the pouch anastomosis at the top of the columns of Morgagni. The incidence
of pouchitis is disappointing but need not be inhibiting of either patients or carrying
out this life-saving procedure in patients with ulcerative colitis and familial polyposis.
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References
- Manometric and functional comparison of ileal pouch anal anastomosis with and without anal manipulation.Am J Surg. 1991; 161: 90-96
- Ileal pouch-anal anastomosis for chronic ulcerative colitis: long-term results.Ann Surg. 1987; 206: 504-513
- Anal continence following Soave procedure: analysis of results in 100 patients.Ann Surg. 1986; 203: 525-530
- Stapled ileo-anal anastomosis for ulcerative colitis and familial polyposis without a temporary diverting ileostomy.Ann Surg. 1991; 213: 606-619
- Preservation of the entire anal canal in conservative proctocolectomy for ulcerative colitis. A pilot study comparing end-to-end ileo-anal anastomosis without mucosal resection, with mucosal protectomy and endoanal anastomosis.Br J Surg. 1987; 74: 940-944
- Cancer in an ileo-anal reservoir: a new late complication.Gut. 1990; 3: 473-475
- Carcinoma of the rectal pouch following restorative proctocolectomy.Dis Colon Rectum. 1992; 35: 257-260
- Anal canal mucosa in restorative proctocolectomy for ulcerative colitis.Br J Surg. 1989; 76: 970-972
- Internal anal sphincter function after total abdominal colectomy and stapled ileal pouch-anal anastomosis without mucosal protectomy.Dis Colon Rectum. 1989; 32: 950-953
- Prospective randomized trial comparing anal function after handsewn ileo-anal anastomosis with mucosectomy in restorative proctocolectomy.Br J Surg. 1991; 78: 430-434
- Preservation of anorectal continence following total colectomy.Ann Surg. 1982; 196: 700-704
- Continuing evolution of the pelvic pouch procedure.Ann Surg. 1992; 216: 506-512
- Ileal pouch-anal anastomosis. Reoperation for pouch-related complications.Ann Surg. 1990; 212: 446-454
- Total colectomy and endorectal ileal pull-through with internal reservoir for ulcerative colitis.Surg Gynecol Obstet. 1980; 150: 1-8
- Three hundred cases of diffuse ulcerative colitis treated by total colectomy and ileo-rectal anastomosis.Br Med J. 1966; 1: 1001-1005
- A personal experience with 100 consecutive total colectomies and straight ileoanal endorectal pull-throughs for benign disease of the colon and rectum in children and adults.Ann Surg. 1990; 212: 242-248
Article info
Footnotes
☆Presented at the Fiftieth Annual Meeting of the Central Surgical Association, Cincinnati, Ohio, March 4–6, 1993.
Identification
Copyright
© 1993 Published by Elsevier Inc.
