Abstract
Endoanal mucosal proctectomy with preservation of the anal sphincters has been employed as an alternative to the traditional method of rectal excision in 23 patients with ulcerative colitis or Crohn's disease. Ten patients in whom the anal canal was left open and drained had uneventful postoperative courses. Of the remaining 13 patients in whom the top of the anal remnant was oversewn, four had local pelvic sepsis that resolved in a few weeks' time and one patient had a pelvic hematoma requiring relaparotomy and sphincter muscle excision. Postoperative disturbances in bladder or sexual function did not occur in any of the patients. At the latest follow-up (mean 21 months), all patients were fully satisfied with the result of the operation. On proctoscopic examination, an anal remnant, measuring approximately 3 cm from the anal verge, could be demonstrated. Its upper end had healed with a fibrous scar in 50 percent of the patients, whereas a small area of friable granulation tissue, sometimes with a short sinus tract was still observed in the others. The persistence of such lesions was associated with minor mucous discharge occasionally escaping from the anal canal. Biopsies disclosed regeneration of cylindric and transitional types of epithelium. The fate of these epithelial remnants remains to be seen. Endoanal mucosal proctectomy appears to be an attractive alternative to the conventional technique. It prevents a great deal of morbidity and enhances postoperative rehabilitation.
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References
Goligher JC. Surgery of the anus, rectum and colon. 5th ed. London: Balliére Tindall, Cassel, 1984:871.
Goligher JC, deDombal FT, Watts JM, Watkinsson G. Ulcerative colitis. London: Balliére, Tindall, Cassel, 1968:301–6.
Warshaw AL, Ottinger LW, Bartlett MK. Primary perineal closure after proctocolectomy for inflammatory bowel disease. Am J Surg 1977;133:414–9.
Silen W, Glotzer D. The prevention and treatment of the perineal sinus. Surgery 1974;75:535–42.
Andersson R, Turnbull RB Jr. Grafting the untreated perineal wound after coloproctectomy for Crohn's disease. Arch Surg 1976;111:335–8.
Bartholdson L, Hultén L. Repair of persistent perineal sinuses by means of a pedicle flap of musculus gracilis. Scand J Plast Reconstr Surg 1975;9:74–6.
Turnbull RB Jr, Fazio V. Advances in the surgical technique of ulcerative colitis surgery. Endoanal proctectomy and two-directional myotomy ileostomy. Vol. 7 New York: Appleton-Century-Crofts 1975:315–29.
Lyttle JA, Parks AG. Intersphincteric excision of the rectum. Br J Surg 1977;64:413–6.
Fallis LS, Barron J. Modified technique for total colectomy in ulcerative colitis. Arch Surg 1953;67:363–9.
Fonkalsrud EW, Ament ME, Byrne W. Clinical experiénce with total colectomy and endorectal mucosal resection for inflammatory bowel disease. Gastroenterology 1979;77:156–60.
Irvin TT, Goligher JC. A controlled clinical trial of three different methods of perineal wound management following excision of the rectum. Br J Surg 1975;62:287–91.
Leicester RJ, Ritchie JK, Wadsworth J, Thomson JPS, Hawley PR. Sexual function and perineal wound healing after intersphincteric excision of the rectum for inflammatory bowel disease. Dis Colon Rectum 1984;27:244–8.
Wolfstein IH, Bat L, Neumann G. Regeneration of rectal mucosa and recurrent polyposis coli after total colectomy and ileoanal anastomosis. Arch Surg 1982;117:1241–2.
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Supported by grants from the Swedish Medical Research Council (No. 3117), from Assar Gabrielsson's Fund.
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Fasth, S., Öresland, T., Åhrén, C. et al. Mucosal proctectomy and ileostomy as an alternative to conventional proctectomy. Dis Colon Rectum 28, 31–34 (1985). https://doi.org/10.1007/BF02553903
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DOI: https://doi.org/10.1007/BF02553903