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Stapled ileal pouch-anal anastomosis with resection of the anal transition zone

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Abstract

We assessed the outcome of stapled ileal J-pouch-anal anastomosis with intersphincteric resection of the anal transition zone in 83 consecutive patients with ulcerative colitis (n=71) or familial adenomatous polyposis (n=12). There was no postoperative mortality. Two patients (2.4%) required permanent ileostomy for manifestation of unsuspected Crohn's disease. Major postoperative complications consisted of pelvic sepsis, anastomotic leakage, and pancreatitis with 3.6% each. Both, frequency of bowel movements and degree of continence improved with time. Two years after takedown of the diverting ileostomy 45 patients with ulcerative colitis and 12 with familial adenomatous polyposis were assessed with a frequency of bowel movements of 5.6±2 and 3.2±1 per 24 h, respectively (P<0.05). At this time none of them had major daytime or nighttime incontinence. Minor incontinence was reported by 9% and 14% of the patients with ulcerative colitis during day-time and night-time, respectively. The patients with familial adenomatous polyposis demonstrated better results, without day-time seepage and intermittent nocturnal seepage in only 9%. It is concluded that direct ileal J-pouch-anal anastomosis is a safe procedure with excellent functional results for patients with ulcerative colitis and familial adenomatous polyposis.

Résumé

Nous avons controlé l'évolution d'anastomose mécanique iléo-anale d'une poche en J avec résection intersphinctérienne de la zone de transition du canal chez 83 patients consécutifs porteurs d'une colite ulcéro-hémorragique (n=71) ou d'une polypose adénomateuse familiale (n=12). Aucune mortalité post-operératoire n'est à déplorer. Deux patients (2,4%) nécessitèrent une iléostomie permanente en raison des manifestations d'une maladie de Crohn non soupçonnée. Les complications postopératoires majeures ont été constituées par une infection pelvienne, un lâchage d'anastomose et une pancréatite avec des incidences de 3,6% pou chacune d'elles. La fréquence des exonérations et le degré de continence se sont amélirés avec le temps. Deux ans après le rétablissement de la continuité iléale, 45 patients porteurs d'une colite ulcéro-hémorragique et 12 porteurs d'une polypose familiale ont été contrôlés avec des fréquences d'exonération respectivement de 5,6±2 et 3,2±1 par 24 h (P<0.05). Lors du contrôle, aucun patient ne présentait d'incontinence majeure diurne ou nocturne. Des incontinences mineures sont retrouvées de jour chez 9% et de nuit chez 14% des sujets opérés pour une colite ulcéro-hémorragique. Des patients porteurs d'une polypose familiale présente de meilleurs résultats sans fuite diurne et des fuites nocturnes intermittentes chez seulement 9%. On conclut de cette étude que l'anastomose directe iléo-anale avec poche en J est un procédé donnant d'excellents résultats fonctionnels chez des patients porteurs d'une colite ulcéro-hémorragique ou d'une polypose familiale.

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Authors and Affiliations

  1. Department of Surgery, Medical Faculty, Rhenish-Westphalian Technical University, Pauwelsstrasse 30, D-52057, Aachen, Germany

    J. Braun, K. H. Treutner & V. Schumpelick

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  1. J. Braun
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  2. K. H. Treutner
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  3. V. Schumpelick
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Braun, J., Treutner, K.H. & Schumpelick, V. Stapled ileal pouch-anal anastomosis with resection of the anal transition zone. Int J Colorect Dis 10, 142–147 (1995). https://doi.org/10.1007/BF00298536

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