+ Site Statistics
References:
54,258,434
Abstracts:
29,560,870
PMIDs:
28,072,757
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Handsewn ileal pouch-anal anastomosis on the dentate line after total proctectomy: technique to avoid incomplete mucosectomy and the need for long-term follow-up of the anal transition zone



Handsewn ileal pouch-anal anastomosis on the dentate line after total proctectomy: technique to avoid incomplete mucosectomy and the need for long-term follow-up of the anal transition zone



Diseases of the Colon and Rectum 44(1): 43-50; Discussion 50-1



During ileal pouch-anal anastomosis, both conservation of the anal transitional zone during the stapled technique and incomplete mucosectomy in the standard Park's procedure may expose the patient to disease recurrence. We propose here an technique whose aim is to solve both problems by performing handsewn ileal pouch-anal anastomosis on the dentate line after rectal eversion and total proctectomy. We reviewed the records of 172 consecutive patients who had undergone ileal pouch-anal anastomosis since 1984 for chronic ulcerative colitis (n = 80), familial adenomatous polyposis (n = 48), selected cases of Crohn's disease (n = 42), or other causes (n = 2). One patient (0.5 percent) died postoperatively. Operative morbidity was similar to that reported after the Park's and stapled procedures. Of our 128 patients with a five-year follow-up, anastomotic stricture occurred in 15 (12 percent), and 4 patients (3 percent) had to have pouch removal. Stool frequency per 24 hours was 4.8 +/- 1.6 (range, 1-11), continence was perfect in 104 patients (81 percent), and sexual activity was estimated to be unchanged in 120 (94 percent). No evidence of disease recurrence was noted in the patients with familial adenomatous polyposis or ulcerative colitis. During ileal pouch-anal anastomosis, Park's procedure carries the risk of incomplete mucosectomy and disease recurrence, and the stapled procedure requires a long-term follow-up of the anal transitional zone. Our alternative technique with total proctectomy avoids both problems and gives similar long-term functional results.

(PDF emailed within 1 workday: $29.90)

Accession: 046211622

Download citation: RISBibTeXText

PMID: 11805562


Related references

Handsewn ileal pouch-anal anastomosis on the dentate line after total proctectomy. Diseases of the Colon & Rectum 44(1): 43-50, 2001

Chronic inflammatory changes in the anal transition zone after stapled ileal pouch-anal anastomosis: is mucosectomy a superior alternative?. Surgery 144(4): 533-7; Discussion 537-9, 2008

Ileal pouch anal function after endoanal mucosectomy and handsewn ileoanal anastomosis compared with stapled anastomosis without mucosectomy. European Journal of Surgery 161(12): 915-921, 1995

Ileal pouch anal function after endoanal mucosectomy and handsewn ileoanal anastomosis versus stapled anastomosis without mucosectomy. European Journal of Surgery 161(12): 922-923, 1995

Can a meta-analysis answer the question: is mucosectomy and handsewn or double-stapled anastomosis better in ileal pouch-anal anastomosis?. American Surgeon 72(10): 912-916, 2006

Stapled ileo-anal anastomosis: a technique to avoid mucosal proctectomy in the ileal pouch operation. British Journal of Surgery 73(7): 571-572, 1986

Adenomatous polyps in the anal transitional zone after ileal pouch-anal anastomosis for familial adenomatous polyposis: treatment by transanal mucosectomy and ileal pouch advancement. British Journal of Surgery 82(12): 1634, 1995

Internal anal sphincter function after total abdominal colectomy and stapled ileal pouch-anal anastomosis without mucosal proctectomy. Diseases of the Colon and Rectum 32(11): 950-953, 1989

High-magnification chromoscopic pouchoscopy: a novel in vivo technique for surveillance of the anal transition zone and columnar cuff following ileal pouch-anal anastomosis. Techniques in Coloproctology 8(3): 173-8; Discussion 178, 2005

Full mucosal proctectomy initiated below the dentate line may prevent the development of a perianal fistula after ileal pouch-anal anastomosis for ulcerative colitis. Digestive Surgery 30(3): 219-224, 2014

Functional outcome of stapled ileal pouch-anal canal anastomosis versus handsewn pouch-anal anastomosis. Surgery Today 30(7): 575-581, 2000

Transanal completion proctectomy after total colectomy and ileal pouch-anal anastomosis for ulcerative colitis: a modified single stapled technique. Colorectal Disease 18(4): O141-O144, 2017

Stapled ileal pouch-anal anastomosis with resection of the anal transition zone. International Journal of Colorectal Disease 10(3): 142-147, 1995

What is the better surgical technique in ileal pouch-anal anastomosis? Mucosectomy. Inflammatory Bowel Diseases 2(2): 151-154, 1996

What Is the Better Surgical Technique in Ileal Pouch-Anal Anastomosis? Mucosectomy. Inflammatory Bowel Diseases 2(2): 151-154, 1996