Abstract
Clinical results and manometric findings were compared in 82 patients following restorative proctocolectomy. There were 41 patients with long rectal cuffs measuring 8 to 10 cm. There were 39 J-shaped pouches and 2 S-shaped pouches in this group. Forty-one patients had short rectal cuffs measuring 2 to 3 cm. There were 28 J-shaped pouches and 13 S-shaped pouches in this group. Anal manometry was performed in ten patients with long rectal cuffs and in ten patients with short rectal cuffs matched for age, sex, and stool frequency. Postoperative complications were significantly greater in patients with long rectal cuffs. Functional results and manometric findings were similar. No patient demonstrated a normal rectoanal inhibitory reflex. The data in this study suggest that a short rectal cuff can be used safely for restorative proctocolectomy with satisfactory results. A normal rectoanal inhibitory reflex may be absent after restorative proctocolectomy, and this does not interfere with the attainment of continence.
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Ritchie JK. Ulcerative colitis treated by ileostomy and excisional surgery: fifteen years experience at St. Mark's Hospital. Br J Surg 1972;59:345–51.
Binder SC, Miller HH, Deterling RA. Fate of the retained rectum after subtotal colectomy for inflammatory disease of the colon. Am J Surg 1976;131:201–3.
Rothenberger DA, Wong WD, Buls JG, Goldberg SM, Christenson CE. Restorative proctocolectomy with ileal reservoir and ileoanal anastomosis for ulcerative colitis and familial polyposis. Dig Surg 1984;1:19–26.
Taylor BM, Beart RW Jr, Dozois RR, Kelly KA, Wolff BG, Ilstrup DM. The endorectal ileal pouch-anal anastomosis: current clinical results. Dis Colon Rectum 1984;27:347–50.
Nicholls J, Pescatori M, Motson RW, Pezim ME. Restorative proctocolectomy with a three-loop ileal reservoir for ulcerative colitis and familial adenomatous polyposis. Ann Surg 1984;199:383–8.
Best RR. Evaluation of ileoproctostomy to avoid ileostomy in various colon lesions. JAMA 1952;150:637–42.
Devine J, Webb R. Resection of the rectal mucosa, colectomy, and anal ileostomy with normal continence. Surg Gynecol Obstet 1951;92:437–42.
Schneider S. Anal ileostomy: experiences with a new three-stage procedure. Arch Surg 1955;70:539–44.
Goligher JC. The functional results after sphincter-saving resections of the rectum. Ann R Coll Surg Engl 1951;8:421–39.
Utsunomiya J, Iwama T, Imajo M, et al. Total colectomy, mucosal proctectomy, and ileoanal anastomosis. Dis Colon Rectum 1980;23:459–66.
Parks AG, Nicholls RJ, Belliveau P. Proctocolectomy with ileal reservoir and anal anastomosis. Br J Surg 1980;67:533–8.
Peck DA. Rectal mucosal replacement. Ann Surg 1980;191:294–303.
Fonkalsrud EW. Endorectal ileoanal anastomosis with isoperistaltic ileal reservoir after colectomy and mucosal proctectomy. Ann J Surg 1984;199:151–7.
Hrabovsky EE, Watne AL, Carrier JM. Changing management in familial polyposis: role of ileoanal endorectal pull-through. Am J Surg 1984;147:130–3.
Williams NS, Johnston D. The current status of mucosal proctectomy and ileo-anal anastomosis in the surgical treatment of ulcerative colitis and adenomatous polyposis. Br J Surg 1985; 72:159–68.
Ravitch MM, Sabiston DC. Anal ileostomy with preservation of the sphincter: a proposed operation in patients requiring total colectomy for benign lesions. Surg Gynecol Obstet 1947; 84:1095–9.
Goligher JC. Eversion technique for distal mucosal proctectomy in ulcerative colitis: a preliminary report. Br J Surg 1984; 71:26–8.
Nicholls J Pezim ME. Restorative proctocolectomy with ileal reservoir for ulcerative colitis and familial adenomatous polyposis: a comparsion of three reservoir designs. Br J Surg 1985;72:470–4.
McHugh S. Unpublished data.
Heppell J, Kelly KA, Phillips SF, Beart RW Jr, Telander RL, Perrault J. Physiologic aspects of continence after colectomy, mucosal proctectomy and ileo-anal anastomosis. Ann Surg 1982;195:435–43.
Pescatori M, Parks AG. The sphincteric and sensory components of preserved continence after ileoanal reservoir. Surg Gynecol Obstet 1984;158:517–21.
Becker JM. Anal sphincter function after colectomy, mucosal proctectomy, and endorectal ileoanal pull-through. Arch Surg 1984;119:526–31.
Neal DE, Williams NS, Johnston D. Rectal, bladder and sexual function after mucosal proctectomy with and without a pelvic reservoir for colitis and polyposis. Br J Surg 1982;69:599–604.
Freckner B. Function of the anal sphincters in spinal man. Gut 1975;16:638–44.
Nagasaki A, Ikeda K, Suita S, Sumitomok K. Induction of the rectoanal reflex by electric stimulation: a diagnostic aid for Hirschsprung's disease. Dis Colon Rectum 1984;27:598–601.
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Read at the meeting of the American Society of Colon and Rectal Surgeons, San Diego, California, May 5 to 10, 1985.
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Grant, D., Cohen, Z., McHugh, S. et al. Clinical results and manometric findings with long and short rectal cuffs. Dis Colon Rectum 29, 27–32 (1986). https://doi.org/10.1007/BF02555281
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DOI: https://doi.org/10.1007/BF02555281