Abstract

Restorative proctocolectomy is now widely accepted as the optimum treatment for ulcerative colitis. However, despite improved surgical techniques and increasing experience the functional outcome is not always good. The four most commonly used determinants of clinical function are stool frequency, continence, ability to defaecate spontaneously and the ability to defer defaecation. However, all these parameters of pouch function are entirely subjective and, depending on their expectations, a good to excellent result for one patient may be a fair or even poor result to another. As a result clinicians have included physiological measurements to explain the variations in pouch function. These measurements have included anal manometry, pouch capacity, pouch compliance, motility and pouch scintigraphy. Pouch ecology has also been studied and attempts have been made to correlate pouch ecology with function.

Keywords

Catheter Fermentation Bromide Barium Dehydration 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Barkel DC, Pemberton JH, Pexim ME et al. (1988) Scintigraphic assessment of the anorectal angle in health and after ileal pouch-anal anastomosis. Ann Surg 208: 42–49PubMedCrossRefGoogle Scholar
  2. Becker JM (1984) Anal sphincter function after colectomy mucosal proctectomy and endorectal ileoanal pull-through. Arch Surg 119: 526–531PubMedCrossRefGoogle Scholar
  3. Braun J, Treutner KH, Harder M, Lerch MM, Tons C, Schumpelick V (1991) Anal sphincter function after intersphincteric resection and stapled ileal pouch-anal anastomosis. Dis Colon Rectum 34: 8–16PubMedCrossRefGoogle Scholar
  4. Brown JJ, Balfe DM, Heiken JP et al. (1990) Ileal J-pouch: radiologic evaluation in patients with and without postoperative infectious complications. Radiology 174: 115–120PubMedGoogle Scholar
  5. Burnham WR, Lennard-Jones JE, Brooke BN (1977) Sexual problems among married ileostomists. Gut 18: 673–677PubMedCrossRefGoogle Scholar
  6. Chaussade S, Michopoulos S, Hautefeuille M, Valleur P, Hautefeuille P, Guerre J, Couturier D. Clinical and physiological study of anal sphincter and ileal J pouch before perileostomy closure and 6–12 months after closure of loop ileostomy. Dig Dis Sci 36: 161–167Google Scholar
  7. Christie PM, Knight GS, Hill GL (1990) Metabolism of body water and electrolytes after surgery for ulcerative colitis: conventional ileostomy versus J pouch. Br J Surg 77: 149–151CrossRefGoogle Scholar
  8. Clarke AM, Chirnside A, Hill GL et al. (1967) Chronic dehydration and sodium depletion in patients with established ileotomies. Lancet 11: 740–743CrossRefGoogle Scholar
  9. de Silva HJ, Jones M, Prince C, Kettlewell M, Mortensen NJ, Jewell DP (1991a) Lymphocyte and macrophage subpopulations in pelvic ileal pouches. Gut 32: 1160–1165PubMedCrossRefGoogle Scholar
  10. de Silva HJ, Millard PR, Kettlewell M, Mortensen NJ, Prince C, Jewell DP (1991b) Mucosal characteristics of pelvic ileal pouches. Gut 32: 61–65PubMedCrossRefGoogle Scholar
  11. de Silva HJ, Millard PR, Soper N, Kettlewell M, Mortensen NJ, Jewell DP (1991c) Effects of the faecal stream and stadid on the ileal pouch mucosa. Gut 32: 1166–1169PubMedCrossRefGoogle Scholar
  12. Dozois RR, Goldberg SM, Rothenberger DA et al. (1986) Symposium on restorative proctocolectomy with ileal reservoir. Int J Colorectal Dis 1: 2–19PubMedCrossRefGoogle Scholar
  13. Emblem R, Erichsen AA, Morkrid L et al. (1989) Failed ileoanal anastomosis: correlations between clinical function and anal canal neurophysiologie and histologic examinations. Scand J Gastroenterol 24: 623–631PubMedCrossRefGoogle Scholar
  14. Everett WG (1989) Expérience of restorative proctocolectomy with ileal reservoir. Br J Surg 76: 77–81PubMedCrossRefGoogle Scholar
  15. Fiorentini MT, Locatelli L, Ceccopieri B et al. (1987) Physiology of ileoanal anastomosis with ileal reservoir for ulcerative colitis and adenomatosis coli. Dis Colon Rectum 30: 267–272PubMedCrossRefGoogle Scholar
  16. Fonkalsrud EW, Loar N (1992) Long-term results after colectomy and endorectal ileal pullthrough procedure in children. Ann Surg 215: 57–62PubMedCrossRefGoogle Scholar
  17. Gorbach SL, Nakas L, Weinstein L (1976) Studies of intestinal microflora. IV. The microflora of ileostomy effluent: a unique microbial ecology. Gastroenterology 53: 874–877Google Scholar
  18. Hallgren T, Fasth S, Nordgren, Oresland T, Hallsberg L, Hulten L (1989) Manovolumetric characteristics and functional results in three different pelvic pouch designs. Int J Colorect Dis 4: 156–160CrossRefGoogle Scholar
  19. Harms BA, Pahl AC, Starling JR (1990) Comparison of clinical and compliance characteristics between S and W ileal reservoirs. Am J Surg 159: 34–40PubMedCrossRefGoogle Scholar
  20. Hatakeyama K, Yamai K, Muto T (1989) Evaluation of ileal W pouch-anal anastomosis for restorative proctocolectomy. Int J Colorect Dis 4: 150–155CrossRefGoogle Scholar
  21. Heald RJ, Allen DR (1986) Stapled ileoanal anastomosis: a technique to avoid mucosal proctectomy in the ileal pouch operation. Br J Surg 73: 571–572PubMedCrossRefGoogle Scholar
  22. Hentges DJ (1983) Role of intestinal microflora in host defences against infection. In: Hentges DJ (ed) Human intestinal microflora in health and disease. Academic Press, New York, pp 311–331Google Scholar
  23. Heppell J, Kelly KA, Phillips SF et al. (1982) Physiologic aspects of continence after colectomy mucosal proctectomy and endorectal ileoanal anastomosis. Ann Surg 195: 435–443PubMedCrossRefGoogle Scholar
  24. Hillard AE, Mann FA, Becker JM, Nelson JA. The ileoanal J pouch: radiographic evaluation. Radiology 155: 591–594Google Scholar
  25. Hojlund PB, Simonsen L, Hansen LK et al. (1985) Bile acid malabsorption in patients with an ileal reservoir with a long efferent leg to an anal anastomosis. Scand J Gastroenterol 20: 995–1000CrossRefGoogle Scholar
  26. Holdsworth PJ, Johnston D (1988a) Anal sensation after restorative proctectomy for ulcerative colitis. Br J Surg 75: 993–996PubMedCrossRefGoogle Scholar
  27. Holdsworth JP, Johnston D (1988b) Use of the end-to-end anastomosis without mucosal stripping diminishes morbidity and time in hospital after restorative proctocolectomy. Br J Surg 75: 1232Google Scholar
  28. Johnston D, Holdsworth PJ, Nasmyth DG et al. (1987) Preservation of the entire anal canal in conservative proctocolectomy for ulcerative colitis: a pilot study comparing end-to-end ileoanal without mucosal resection with mucosal proctectomy and endo-anal anastomosis. Br J Surg 74: 940–944PubMedCrossRefGoogle Scholar
  29. Kawarasaki H, Fujiwara T, Fonkalsrud EW (1985) Electric activity and motility in the side-to-side isoperistaltic ileal reservoir. Arch Surg 120: 1045–1047PubMedCrossRefGoogle Scholar
  30. Keighley MRB, Kmiot W (1990) Surgical options in ulcerative colitis: role of ileo-anal anastomosis. Aust NZ Surg 60: 835–845CrossRefGoogle Scholar
  31. Keighley MRB, Winslet MC, Yoshioka K, Lightwood R (1987) Discrimination is not impaired by excision of the anal transition zone after restorative proctocolectomy. Br J Surg 74: 1118–1121PubMedCrossRefGoogle Scholar
  32. Keighley MRB, Yoshioka K, Kmiot W (1988a) Prospective randomised trial to compare the stapled double lumen pouch and the sutured quadruple pouch for restorative proctocolectomy. Br J Surg 75: 1008–1011PubMedCrossRefGoogle Scholar
  33. Keighley MRB, Yoshioka K, Kmiot W, Heyen F (1988b) Physiological parameters influencing function in restorative proctocolectomy and ileal pouch-anal anastomosis. Br J Surg 75: 997–1002PubMedCrossRefGoogle Scholar
  34. Kelly DG, Phillips SF, Kelly KA et al. (1983) Dysfunction of the continent ileostomy: clinical features and bacteriology. Gut 24: 193–201PubMedCrossRefGoogle Scholar
  35. Kelly KA (1992) Anal sphincter saving operations for chronic ulcerative colitis. Am J Surg 163: 5–11PubMedCrossRefGoogle Scholar
  36. Kennedy HJ, Al-Dujaili EAS, Edwards CRW et al. (1983) Water and electrolyte balance in subjects with a permanent ileostomy. Gut 24: 702–705PubMedCrossRefGoogle Scholar
  37. Kmiot WA, Yoshioka K, Pinho M, Keighley MRB (1990) Videoproctographic assessment after restorative proctocolectomy. Dis Colon Rectum 33: 566–572PubMedCrossRefGoogle Scholar
  38. Kumar D, Waldron D, Nicholls RJ, Williams NS (1989) Motor functon of the ileal reservoir following restorative proctocolectomy. Gastroenterology 96: A276Google Scholar
  39. Lerch MM, Braun J, Harder M et al. (1989) Postoperative adaptation of the small intestine after total colectomy and J pouch-anal anastomosis. Dis Colon Rectum 32: 600–608PubMedCrossRefGoogle Scholar
  40. Levitt MD, Kamm MA, Nicholls RJ (1991) Pouch dynamics — a simple test of ileoanal pouch evacuation. 6: 158–160Google Scholar
  41. Lindquist K (1990) Anal manometry with microtransducer technique before and after restorative proctocolectomy. Sphincter function and clinical correlations. Dis Colon Rectum 33: 91–98PubMedCrossRefGoogle Scholar
  42. Marzouk D, Williams NS, Hallan RI (1989) Function after stapled ileal pouch-anal anastomosis for ulcerative colitis. Br J Surg 76: A627Google Scholar
  43. Miller R, Orrom WJ, Duthie et al. (1990) Ambulatory anorectal physiology in patients following restorative proctocolectomy for ulcerative colitis: comparison with normal controls. Br J Surg 77: 895–897PubMedCrossRefGoogle Scholar
  44. Mortensen N (1988) Progress with pouch-restorative proctocolectomy for ulcerative colitis. Gut 29: 561–565PubMedCrossRefGoogle Scholar
  45. Nasmyth DG, Williams NS, Johnston D (1986) Comparison of the function of triplicated and duplicated pelvic deal reservoirs after mucosal proctectomy and ileoanal anastomosis for ulcerative colitis and adenomatous polyposis. Br J Surg 73: 361–366PubMedCrossRefGoogle Scholar
  46. Nasmyth DGN, Godwin PGR, Dixon MF, Williams NS, Johnstone D (1989a) Ileal ecology after pouch-anal anastomosis or ileostomy. Gastroenterology 96: 817–824PubMedGoogle Scholar
  47. Nasmyth DG, Johnston D, Williams NS, King RFG, Burkinshaw L, Brooks K (1989b) Changes in the absorption of bile acids after total colectomy in patients with an ileostomy or pouch-anal anastomosis. Dis Colon Rectum 32: 230–234PubMedCrossRefGoogle Scholar
  48. Neal DE, Parker AJ, Williams NS et al. (1982a) The longterm effects of proctectomy on bladder function in patients with inflammatory bowel disease. Br J Surg 69: 349–352PubMedCrossRefGoogle Scholar
  49. Neal DE, Williams NS, Johnston D (1982b) Rectal, bladder and sexual function after mucosal proctectomy with and without a pelvic reservoir for colitis and polyposis. Br J Surg 69: 599–604PubMedCrossRefGoogle Scholar
  50. Nicholls RJ (1987) Restorative proctocolectomy with various types of reservoir. World J Surg 11: 751–762PubMedCrossRefGoogle Scholar
  51. Nicholls RJ, Lubowski DZ (1987) Restorative proctocolectomy: the four loop (W) reservoir. Br J Surg 74: 564–566PubMedCrossRefGoogle Scholar
  52. Nicholls RJ, Pezim ME (1985) Restorative proctocolectomy with ileal reservoir for ulcerative colitis and familial adenomatous polyposis: a comparison of three reservoir designs. Br J Surg 72: 470–474PubMedCrossRefGoogle Scholar
  53. O’Connell PR, Rankin DR, Weiland LH, Kelly KA (1986) Enteric bacteriology, absorption, morphology and emptying after ileal pouch-anal anastomosis. Br J Surg 73: 909–914PubMedCrossRefGoogle Scholar
  54. O’Connell PR, Pemberton JH, Brown ML et al. (1987) Determinants of stool frequency after ileal pouch-anal anastomosis. Am J Surg 153: 157–163PubMedCrossRefGoogle Scholar
  55. O’Connell PR, Stryker SJ, Metcalf AM et al. (1988) Anal canal pressure and motility after ileoanal anastomosis. Surg Gynecol Obstet 166: 47–54PubMedGoogle Scholar
  56. Oresland T, Fasth S, Nordgren S, Akervall S, Hulten L (1990) Pouch size: the important functional determinant after restorative proctocolectomy. Br J Surg 77: 265–269PubMedCrossRefGoogle Scholar
  57. Pemberton JH, Kelly KA, Beast RW et al. (1987) Ileal pouch-anal anastomosis for chronic ulcerative colitis: long-term results. Ann Surg 206: 504–513PubMedCrossRefGoogle Scholar
  58. Pescatori M, Parks AG (1984) The sphincteric and sensory components of preserved continence after ileoanal reservoir. Surg Gynecol Obstet 158: 517–521PubMedGoogle Scholar
  59. Pescatori M, Manhire A, Bartram CI Evacuation pouchography in the evaluation of ileoanal reservoir function. Dis Colon Rectum 26: 365–368Google Scholar
  60. Phillips SF, Giller J (1973) The contribution of the colon to electrolyte and water conservation in man. J Lab Clin Med 81: 733–746PubMedGoogle Scholar
  61. Rosemurgy AS, Schraut WH, Block GE (1983) The physiological effects of deal reservoirs and efferent conduits complementing ileoanal anastomosis: an experimental study in dogs. Surgery 94: 697–703PubMedGoogle Scholar
  62. Rothenberger DA, Wong WD, Buls JG, Goldberg SM (1985) In: Dozois RR (ed) Alternatives to conventional ileostomy. Yearbook Medical, Chicago, pp 345–362Google Scholar
  63. Sagar PM, Holdsworth PJ, Godwin GR, Quirke P, Smith AN, Johnstone D (1992) Comparison of triplicated (S) and quadruplicated (W) pelvic ileal reservoirs: studies on manovolumetry, fecal bacteriology, fecal volatile fatty acids, mucosal morphology, and function results. Gastroenterology 102: 520–528PubMedGoogle Scholar
  64. Santavirta J, Harmoninen A, Karvonen AL, Matikainen M (1991a) Water and electrolyte balance after ileoanal anastomosis. Dis Colon Rectum 34: 115–118PubMedCrossRefGoogle Scholar
  65. Santavirta J, Mattila J, Kokki M, Matikainen M (1991b) Mucosal morphology and faecal bacteriology after ileoanal anastomosis. Int J Colorec Dis 6: 38–41CrossRefGoogle Scholar
  66. Sharp FR, Bell GA, Seal AM, Atkinson KG (1987) Investigations of the anal sphincter before and after restorative proctocolectomy. Am J Surg 153: 496–472CrossRefGoogle Scholar
  67. Shepherd NA, Jass JR, Duval I, Moskowitz RL, Nicholls RJ, Morson BC (1987) Restorative proctocolectomy with ileal reservoir: pathological and histochemical study of mucosal biopsy specimens. J Clin Pathol 40: 601–607PubMedCrossRefGoogle Scholar
  68. Shepherd NA, Jass JR, Duval I et al. (1989) Restorative proctocolectomy with ileal reservoir: a pathological and histochemical study of mucosal biopsy specimens. J Clin Pathol 40: 601–607CrossRefGoogle Scholar
  69. Stryker SJ, Kelly KA, Phillips SF et al. (1986) Anal and neorectal function after proctocolectomy and deal pouch-anal anastomosis. Ann Surg 203: 55–61PubMedCrossRefGoogle Scholar
  70. Sugarman HJ, Newsome HH, Decosta G, Zfass AM (1991) Stapled ileoanal anastomosis for ulcerative colitis and familial polyposis without a temporary diverting ileostomy. Ann Surg 213: 606–619CrossRefGoogle Scholar
  71. Taylor BM, Beart RW, Dozois RR, Kelly KA, Phillips SF (1983) Straight ileoanal anastomosis v. ileal pouch-anal anastomosis after colectomy and mucosal proctectomy. Arch Surg 118: 696–701PubMedCrossRefGoogle Scholar
  72. Thayer ML, Madoff RD, Jacobs DM, Bubrick MP (1990) Comparative intrinsic and extrinsic compliance characteristics of S, J and W ileoanal pouches. Dis Colon Rectum 33: 86Google Scholar
  73. Tuckson WB, Fazio VW (1991) Functional comparison between double and triple ileal loop pouches. Dis Colon Rectum 34: 17–21PubMedCrossRefGoogle Scholar
  74. Watts J McK, de Dombal FT, Goligher JC (1966) Longterm complications and prognosis following major surgery for ulcerative colitis. Br J Surg 53: 1014–1023PubMedCrossRefGoogle Scholar
  75. Wexner SD, James K, Jagelman DG (1991) The double-spaced ileal reservoir and ileoanal anastomosis: a prospective review of sphincter function and clinical outcome. Dis Colon Rectum 34: 487–494PubMedCrossRefGoogle Scholar
  76. Williams NS, Johnston D (1985) The current status of mucosal proctectomy and ileoanal anastomosis in the surgical treatment of ulcerative colitis and adenomatous polyposis. Br J Surg 72: 159–168PubMedCrossRefGoogle Scholar
  77. Williams NS, Marzouk DEMM, Hallan RI, Waldron DJ (1989) Function after ileal pouch and stapled pouch-anal anastomosis for ulcerative colitis. Br J Surg 76: 1168–1171PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 1993

Authors and Affiliations

  • D. Kumar

There are no affiliations available

Personalised recommendations