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Functional outcome after pouch-anal reconstruction with primary and secondary mucosectomy for patients with familial adenomatous polyposis (FAP)

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Abstract

Introduction

Restorative proctocolectomy and ileal pouch-anal reconstruction is the surgical standard for the majority of patients with familial adenomatous polyposis (FAP). The pouch-anal anastomosis may be performed handsewn after primary mucosectomy or by double stapling. Better functional results favour the latter; however, higher rates of remaining rectal mucosa with adenomas often necessitate secondary mucosectomy. Data on functional outcome after secondary mucosectomy is scarce. The aim of the study was to analyse whether patients who undergo secondary mucosectomy maintain their functional benefits compared to patients with primary mucosectomy.

Patients and methods

Twenty patients after secondary mucosectomy and 31 patients after primary mucosectomy were compared with respect to their functional outcome, using the MSKCC score, the Wexner score and ano-rectal physiology testing.

Results

The MSKCC global score and the Wexner score showed a non-significant trend towards slightly better results after secondary mucosectomy (63.1 vs. 56.6, p = 0.0188 and 9.5 vs. 11, p = 0.3780). Patients after secondary mucosectomy also showed a tendency towards less bowel movements per 24 h (7 (range 4–11) vs. 8.5 (range 3–20), p = 0.1518). Resting pressures were slightly higher after secondary (44 vs. 39.6 mmHg, p = 0.4545) and squeeze pressures slightly higher after primary mucosectomy (87.6 vs. 81.2 mmHg, p = 0.6126). However, the results did not reach statistical significance.

Conclusion

The results of this study cannot ultimately resolve the controversy concerning handsewn versus stapled ileal pouch-anal anastomosis. Our results suggest a trend towards better functional results after stapled anastomosis with secondary mucosectomy.

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Authors and Affiliations

  1. Department of General, Visceral, and Transplant Surgery, University of Heidelberg, Heidelberg, Germany

    Petra Ganschow, Irmgard Treiber & Ulf Hinz

  2. Department of General, Visceral, and Transplantation Surgery, Ludwig-Maximilians University, Marchionini-Str. 1581377, Munich, Germany

    Petra Ganschow

  3. School of Medicine University of Augsburg, Augsburg, Germany

    Martina Kadmon

Authors
  1. Petra Ganschow
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  2. Irmgard Treiber
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  3. Ulf Hinz
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  4. Martina Kadmon
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Contributions

P.G.: primary author of manuscript, conceptual development of study, acquisition of data, analysis and interpretation of results. I.T.: acquisition of data, analysis and interpretation of results. U.H.: critical review of study design, statistical analysis of data, interpretation of data, interpretation of results, statistical counselling of study. M.K.: conceptual development of study, analysis and interpretation of results, critical review of manuscript and possible impact on clinical management.

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Correspondence to Petra Ganschow.

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All authors declare that they had no conflict of interest concerning the presented study.

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Ganschow, P., Treiber, I., Hinz, U. et al. Functional outcome after pouch-anal reconstruction with primary and secondary mucosectomy for patients with familial adenomatous polyposis (FAP). Langenbecks Arch Surg 404, 223–229 (2019). https://doi.org/10.1007/s00423-018-1747-1

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