Summary
Ileal pouch anal anastomosis (IPAA) after proctocolectomy has a technically difficult surgical procedure in addition to the complications of loop anastomosis and pouchitis. A simplified technique of pouch construction is presented. Eight patients were operated on (age 38.2 years; 5 women, 3 men) for ulcerative colitis (n=5) and familial polyposis (n=3). Proctocolectomy was performed and a neorectum constructed. An ileal segment of 50 cm was aligned so that 3 loops lay horizontally one above the other. Serosal sutures approximated each 2 adjacent limbs. Myectomy, 1×10 cm, was performed in each limb. Ileoanal anastomosis was then done. Patients were followed for a mean of 21.3 months. Multiple mucosal tears occurred in the first 3 patients and were sutured. No anastomotic leak occurred; ileoanal anastomotic stenosis occurred in 1 case. Patients were continent. Mean stool frequency 18 months postoperatively was 3.4±0.9 during the day and 1.1±0.3 during night-time. The mean reservoir capacity 6 months after operation was 686.3±72.5 ml. Pouchometry displayed a horizontal plateau with fluctuations. Fecoflowmetry produced a curve full of fluctuations. In conclusion, the presented technique seems to be easier and has less complications than the other procedures used for pouch construction. Meanwhile, it achieves the functional results of continence and less frequent evacuations.
Zusammenfassung
Die anale Anastomose mit Ileumpouch nach Proktokolektomie ist eine technisch schwierige Operationsmethode mit den zusätzlichen Komplikationen von Schlingenanastomose und Pouchitis. Es wird eine vereinfachte Technik der Pouchanlage dargestellt. Wir operierten acht Patienten (Durchschnittsalter 38,2 Jahre; fünf Frauen, drei Männer) mit Colitis ulcerosa (n=5) und familiärer Polyposis (n=3). Nach der Proktokolektomie wurde das Neorektum gebildet. Ein Ileumsegment von 50 cm Länge wurde so angeordnet, daß drei Schlingen horizontal jeweils übereinanderlagen. Mit Serosanähten wurden jeweils zwei aneinanderliegende Segmente vernäht. In jedem Schenkel erfolgte eine 1×10 cm große Myektomie. Danach wurde die ileoanale Anastomose durchgeführt. Die Nachuntersuchung der Patienten erstreckte sich über einen durchschnittlichen Zeitraum von 21,3 Monaten. Bei den ersten drei Patienten kam es zu multiplen Mukosarissen, die vernäht wurden. Wir sahen keine Anastomosendehiszenz; eine Stenose der ileoanalen Anastomose trat in einem Fall auf. Die Patienten waren kontinent. Die durchschnittliche Stuhlfrequenz betrug 18 Monate postoperativ 3,4±0,9 während des Tages und, 1,1±0,3 während der Nacht. Die durchschnittliche Pouchkapazität sechs Monate postoperativ lag bei 686,3±72,5 ml. In der Pouchometrie ergab sich ein horizontales Plateau mit Fluktuationen. Die Fäkoflowmetrie zeigte eine Kurve von zahlreichen Fluktuationen. Die vorgestellte Technik scheint technisch leichter zu sein und zeigt weniger Komplikationen als andere. Methoden der Pouchanlage. Als funktionelles Ergebnis werden Kontinenz und weniger häufige Entleerungen erreicht.
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Shafik, A. Ileal reservoir anal anastomosis. Coloproctol 19, 89–94 (1997). https://doi.org/10.1007/BF03043694
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DOI: https://doi.org/10.1007/BF03043694