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Stricture at the pouch-anal anastomosis after restorative proctocolectomy

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  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: The aim of this study was to determine what factors may be responsible for the development of a stricture at the pouch-anal anastomosis after restorative proctocolectomy. METHODS: A consecutive series of 115 patients was studied retrospectively a median of 34 months (range, 4–100 months) after operation or ileostomy closure. The procedure failed in 11 patients (9.6 percent) who subsequently had to have a permanent ileostomy. Another two patients were excluded from the analysis, one of whom was awaiting ileostomy closure, whereas the other had a stricture due to a desmoid tumor. Of the remaining 102 patients, 39 (38 percent) developed an ileoanal anastomotic stricture, which was severe and persistent in 16 percent. RESULTS: The results were analyzed with the aid of multivariate logistic regression analysis. Factors which predisposed significantly to the development of an ileoanal anastomotic stricture were 1) use of the 25-mm (small) diameter stapling gun (P<0.05), 2) use of a quadruplicated reservoir (P=0.05), 3) use of a defunctioning ileostomy (P=0.03), and 4) anastomotic dehiscence and pelvic sepsis (P=0.03). The single patient whose operation failed because of a stricture had also developed pelvic sepsis associated with an anastomotic dehiscence. CONCLUSIONS: The eventual clinical, functional outcome after dilation of a stricture in the 39 patients who developed a stricture was as good as the outcome in the 63 patients who did not a develop stricture.

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Authors and Affiliations

  1. Academic Unit of Surgery, The General Infirmary, Great George Street, LS1 3EX, Leeds, UK

    Wyn G. Lewis F.R.C.S., Ayhan Kuzu M.D., Peter M. Sagar F.R.C.S., Peter J. Holdsworth F.R.C.S. & David Johnston M.D.

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  1. Wyn G. Lewis F.R.C.S.
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  2. Ayhan Kuzu M.D.
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  3. Peter M. Sagar F.R.C.S.
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  4. Peter J. Holdsworth F.R.C.S.
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  5. David Johnston M.D.
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Lewis, W.G., Kuzu, A., Sagar, P.M. et al. Stricture at the pouch-anal anastomosis after restorative proctocolectomy. Dis Colon Rectum 37, 120–125 (1994). https://doi.org/10.1007/BF02047532

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