Abstract
Thirty-two ileoanal J-pouch procedures have been performed by the author between 1983 and 1986. Two pouches have been excised, one has been defunctioned for diarrhea, and seven patients either have not had their ileostomy closed or have not been followed for more than four months after restoration of intestinal continuity. Of the remaining 22 patients, 12 early operations involved endoanal mucosectomy while in the ten most recent procedures, the rectum and anal mucosa have been excised from the abdomen. Incidence of complications between the methods of mucosal excision were comparable apart from cuff abscess (n=5) which only occur after endoanal muscosectomy. Functional results were identical apart from the incidence of soiling which occurred in six of 12 patients after endoanal mucosectomy but in only one of ten patients after abdominal mucosectomy. Resting anal canal pressures fell significantly after endoanal mucosectomy (87 to 60cm H20,P<0.05) but not after abdominal mucosectomy (87 to 81 cm H20). These differences may be due to the duration and extent of anal retraction, which was 72 minutes after endoanal mucosectomy but only 18 minutes after abdominal mucosectomy. Abdominal mucosectomy appears to cause less sphincter damage and soiling than conventional endoanal excision.
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Taylor BM, Cranley B, Kelly KA, Phillips SF, Beart RW Jr, Dozois RR. A clinico-physiological comparison of ileal pouch-anal and straight ileoanal anastomoses. Ann Surg 1983;198:462–8.
Nicholls J, Pescatori M, Motson RW, Pezim ME. Restorative proctocolectomy with a three-loop ileal reservoir for ulcerative colitis and familial adenomatous polyposis: clinical results in 66 patients followed for up to 6 years. Ann Surg 1984;199:383–8.
Fonkalsrud EW. Endorectal ileoanal anastomosis with isoperistaltic ileal reservoir after colectomy and mucosal proctectomy. Ann Surg 1984;199:151–7.
Dozois RR. Heal ‘J’ pouch-anal anastomosis. Br J Surg 1985; 72(suppl):S80-S2.
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.
Rothenberger DA, Vermeulen FD, Christenson CE, et al. Restorative proctocolectomy with ileal reservoir and ileoanal anastomosis. Am J Surg 1983;145:82–8.
Shouler P, Keighley MR. Changes in colorectal function in severe idiopathic chronic constipation. Gastroenterology 1986;90:414–20.
Farthing MJ, Lennard-Jones JE. Sensibility of the rectum to distension and the anorectal distension reflex in ulcerative colitis. Gut 1978;19:64–9.
Heald RJ, Allen DR. Stapled ileo-anal anastomosis: a technique to avoid mucosal proctectomy in the ileal pouch operation. Br J Surg 1986;73:571–2.
Cohen Z, McLeod RS, Stern H, Grant D, Nordgren S. The pelvic pouch and iloeanal anastomosis procedure: surgical technique and initial results. Am J Surg 1985;150:601–7.
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.
Nicholls RJ, Pezim ME. Restorative proctocolectomy with ileal reservoir for ulcerative colitis and familial adenomatous polyposis: a comparison of three reservoir designs. Br J Surg 1985; 72:470–4.
Rothenberger DA, Wong WD, Buls JG, Goldberg SM. The S ileal pouch-anal anastomosis. In: Dozois RR, ed. Alternatives to conventional ileostomy. Chicago: Year Book Medical Publishers, 1985:345–66.
Hancock BD. Measurement of anal pressure and motility. Gut 1976;17:645–51.
Keighley MR, Buchmann P, Minervini S, Arabi Y, Alexander-Williams J. Prospective trials of minor surgical procedures and diet for haemorrhoids. Br Med J [Clin Res] 1979;2: 967–9.
Keighley MR. Anal sphincter function and sphincter preserving surgery. Ann Chir Gynaecol 1986;75:121–6.
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Keighley, M.R.B. Abdominal mucosectomy reduces the incidence of soiling and sphincter damage after restorative proctocolectomy and J-pouch. Dis Colon Rectum 30, 386–390 (1987). https://doi.org/10.1007/BF02555460
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DOI: https://doi.org/10.1007/BF02555460