Manometric follow-up of anal sphincter function after an ileo-anal pouch procedure

Abstract

Between January 1985 and January 1987 restorative proctocolectomy with J-pouch was undertaken in 20 patients with ulcerative colitis. In all patients anal manometry was performed preoperatively, before closure of the temporary ileostomy (mean 3.9 months after operation) and 3, 6 and 12 months after the closure of the ileostomy. Preoperatively the basal resting pressure was 60.2±12 cm water and the maximum squeeze pressure 88.5 ±18 cm water. After the operation the respective pressures were 33.2 ±8 and 68 ±21 cm water, a decrease of 45% (p<0.05) and 12% (p<0.05), respectively. One year after the closure of the loop ileostomy the basal pressure was 46.2 ±9 cm water, which is still 23% lower (p<0.05) than preoperatively. At the same time the maximum squeeze pressure was 96.5 ± 13 cm water, 8% higher (p>0.1) than preoperatively. The continence of the patients at the end of the follow-up was either good (n=6) or excellent (n=9). A correlation seemed to exist between sphincter pressures and the degree of continence. It is concluded that the internal anal sphincter suffers damage during the operation and slowly recovers up to 6 months after closure of the covering ileostomy. After that its function usually does not improve and remains at a lower level than preoperatively.