Abstract
PURPOSE: Patients with an ileal pouch-anal anastomosis may develop impaired evacuation of the pouch. A new surgical approach and the role of dynamic defecography in such patients are highlighted. METHODS: Five patients with ileal pouch-anal anastomosis were assessed clinically and with dynamic defecography before and after reoperation. RESULTS: In one patient an extensive approach with complete pouch mobilization, stenoplasty of a pouch outlet stenosis, shortening of the rectal remnant, and renewed pouch-anal anastomosis were needed; in three patients, a long and angulated efferent limb was shortened by transabdominal techniques (stenoplasty or a newly developed technique with a linear stapler), and in one patient a pouch inlet stenosis was corrected. In all patients, impaired emptying was cured; in all patients, obstructive abdominal pain improved considerably. CONCLUSIONS: Dynamic defecography is indispensable for tailoring surgical treatment. Effective transabdominal shortening of the efferent limb can be performed with the aid of a linear stapler.
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Silvis, R., Delemarre, J.B.V.M. & Gooszen, H.G. Surgical treatment and role of dynamic defecography in impaired evacuation after ileal pouch-anal anastomosis. Dis Colon Rectum 40, 84–88 (1997). https://doi.org/10.1007/BF02055687
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DOI: https://doi.org/10.1007/BF02055687