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Improvement of anal sensation with preservation of the anal transition zone after ileoanal anastomosis for ulcerative colitis

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Diseases of the Colon & Rectum

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Abstract

One of the most important considerations in restorative proctocolectomy for ulcerative colitis is postoperative continence. Preservation of the anal transition zone has been associated with improved results after this procedure in the pediatric age group. This study was carried out to determine the effect of preservation of the amal transition zone in adult patients undergoing restorative proctocolectomy, comparing a group of patients with the anal transition zone preserved with a group of patients with the anal transition zone removed. Physiologic testing demonstrated improved sensation in those patients with a preserved anal transition zone. Functional results were not significantly improved, although there was a trend toward improved continence and discrimination in those with the anal transition zone preserved. Although the results are early and are not conclusive from the clinical standpoint, they are certainly encouraging and may justify continued use of this technique.

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References

  1. Pemberton JH, Kelly KA, Beart RW, Dozois RR, Wolff BG, Ilstrup DM. Ileal pouch-anal anastomosis for chronic ulcerative colitis: long-term results. Ann Surg 1987;206:504–11.

    PubMed  Google Scholar 

  2. Pescatori M, Mattana C, Castagneto M. Clinical and functional results after restorative proctocolectomy. Br J Surg 1988;75:321–4.

    PubMed  Google Scholar 

  3. Nicholls RJ, Pescatori M, Motson RW, Pezim ME. Restorative proctocolectomy with three loop ileal reservoir for ulcerative colitis and familial adenomatous polyposis. Ann Surg 1984;199:383–8.

    PubMed  Google Scholar 

  4. Wong WD, Rothenberger DA, Goldberg SM. Ileoanal pouch procedures. Curr Probl Surg 1985;22:1–78.

    Google Scholar 

  5. Martin LW, Fischer JE, Sayers HJ, Alexander F, Torres MA. Anal continence following Soave procedure: analysis of results in 100 patients. Ann Surg 1986;203:525–30.

    PubMed  Google Scholar 

  6. Duthie HL, Gairns FW. Sensory nerve-endings and sensation in the anal region of man. Br J Surg 1960;47:585–95.

    PubMed  Google Scholar 

  7. Duthie HL, Gairns FW. The relation of sensation in the anal canal to the functional anal sphincter: a possible factor in anal continence. Gut 1963;4:179–82.

    Google Scholar 

  8. Roe AM, Bartolo DC, Mortensen NC. New method for assessment of anal sensation in various anorectal disorders. Br J Surg 1986;73:310–12.

    PubMed  Google Scholar 

  9. Miller R, Bartolo DC, Cervero F, Mortensen NJ. Anorectal temperature sensation: a comparison of normal and incontinent patients. Br J Surg 1987;74:511–15.

    PubMed  Google Scholar 

  10. Bartolo DC, Roe AM, Virjee J, Mortensen NJ, Locke-Edmunds JC. An analysis of rectal morphology in obstructed defecation. Int J Color Dis 1988;3:17–22.

    Google Scholar 

  11. Roe AM, Bartolo DC, Mortensen NJ. Diagnosis and surgical management of intractable constipation. Br J Surg 1986;73:854–61.

    PubMed  Google Scholar 

  12. Read MG, Read NW. Role of anorectal sensation in preserving continence. Gut 1982;23:345–7.

    PubMed  Google Scholar 

  13. Keighley MR, Winslet MC, Yoshioka K, Lightwood R. Discrimination is not impaired by excision of the anal transition zone after restorative proctocolectomy. Br J Surg 1987;74:1118–21.

    PubMed  Google Scholar 

  14. Johnston D, Holdsworth PJ, Nasmyth DG, et al. Preservation of the entire anal canal in conservative proctocolectomy for ulcerative colitis: a pilot study comparing end-to-end ileo-anal anastomosis without mucosal resection with mucosal proctectomy and endo-anal anastomosis. Br J Surg 1987;74:940–4.

    PubMed  Google Scholar 

  15. Pescatori M, Parks AG. The sphincteric and sensory components of preserved continence after ileoanal reservoir. Surg Gynecol Obstet 1984;158:517–21.

    PubMed  Google Scholar 

  16. Keighley MR. Abdominal mucosectomy reduces the incidence of soiling and sphincter damage after restorative proctocolectomy and J-pouch. Dis Colon Rectum 1987;30:386–90.

    PubMed  Google Scholar 

  17. Neal DE, Williams NS, Johnston D. Rectal, bladder, and sexual function after mucosal proctectomy with and without a pelvic ileal reservoir for colitis and polyposis. Br J Surg 1982;69:599–604.

    PubMed  Google Scholar 

  18. Mendelstam DA. Fecal incontinence: social and economic factors. In: Henry MM, Swash M. Coloproctology and the pelvic floor: pathophysiology and management. London: Butterworths, 1985:217–22.

    Google Scholar 

  19. Deasy JM, Quirke P, Dixon M, Lagopoulos M, Johnston D. The surgical importance of the anal transition zone in ulcerative colitis. Br J Surg 1987;74:533.

    Google Scholar 

  20. O'Connell PR, Pemberton JH, Weiland LH, et al. Does rectal mucosa regenerate after ileoanal anastomosis? Dis Colon Rectum 1987;30:1–5.

    PubMed  Google Scholar 

  21. Devroede G. Risk of cancer in inflammatory bowel disease. In: Winawer SJ, Schottenfeld D, Sherlock P. Colorectal cancer: prevention, epidemiology, and screening. New York: Raven Press, 1980:325–34.

    Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Bristol Royal Infirmary, BS2 8HW, Bristol, UK

    Richard Miller M.S., F.R.C.S.,  David C. C. Bartolo M.S., F.R.C.S., A. M. Roe M.S., F.R.C.S. & F. Cervero Ph.D.

  2. Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota

    William J. Orrom M.SC, F.R.C.S.(C)

  3. John Radcliffe Hospital, Oxford, UK

    N. J. McC Mortensen M.D., F.R.C.S.

Authors
  1. Richard Miller M.S., F.R.C.S.
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  2. David C. C. Bartolo M.S., F.R.C.S.
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  3. William J. Orrom M.SC, F.R.C.S.(C)
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  4. N. J. McC Mortensen M.D., F.R.C.S.
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  5. A. M. Roe M.S., F.R.C.S.
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  6. F. Cervero Ph.D.
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Additional information

Read at the XIIth Biennial Congress of the International Society of University Colon and Rectal Surgeons, Glasgow, Scotland, July 10 to 14, 1988.

Mr. Richard Miller is supported by a grant from the medical research council.

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Miller, R., Bartolo, D.C.C., Orrom, W.J. et al. Improvement of anal sensation with preservation of the anal transition zone after ileoanal anastomosis for ulcerative colitis. Dis Colon Rectum 33, 414–418 (1990). https://doi.org/10.1007/BF02156269

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  • DOI: https://doi.org/10.1007/BF02156269

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