Abstract
One technique used during restorative proctocolectomy to prevent loss of continence involves preservation of the anal canal. This technique retains a small amount of colonic mucosa and transitional mucosa that may become inflamed or develop dysplastic or neoplastic changes. PURPOSE: This study was designed to determine the presence and severity of anal canal inflammation and the need for treatment. METHOD: Records of 217 patients with mucosal ulcerative colitis who underwent restorative proctocolectomy with a stapled ileal pouch-anal anastomosis without anal mucosectomy from 1987 through 1990 were retrospectively reviewed. RESULTS: Anal canal inflammation was evident on both endoscopy and biopsy in 48 patients (22.11 percent); 18 patients (8.29 percent) had a normal ileal pouch (9 had symptoms; 5 required topical treatment), and 30 patients (13.82 percent) had associated ileal pouch inflammation (23 with symptoms requiring systemic treatment because of pouchitis; 10 patients had concomitant topical treatment). CONCLUSION: Symptomatic inflammation of the retained mucosa occurred in 32 (14.7 percent) patients. Nine (4.1 percent) patients had inflammation of the anal canal alone, and 23 (10.6 percent) had pouchitis in addition. The need for treatment occurred in 28 (12.9 percent) of the total ((2.3 percent) patients with anal canal inflammation and 23 (10.6 percent) with anal canal inflammation plus pouchitis).
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References
Parks AG, Nicholls RJ, Belliveau P. Proctocolectomy with ileal reservoir and anal anastomosis. Br J Surg 1980;67:533–8.
Pezim ME, Nicholls RJ. Quality of life after restorative proctocolectomy with pelvic ileal reservoir. Br J Surg 1985;72:31–3.
Wexner SD, Jensen L, Rothenberger DA, Wong WE, Goldberg SM. Long-term functional analysis of the ileoanal reservoir. Dis Colon Rectum 1989;32:275–81.
Pemberton JH, Phillips SF, Ready RR, Zinsmeister AR, Beahrs OH. Quality of life after Brooke Ileostomy and ileal pouch-anal anastomosis. Ann Surg 1989;5:620–8.
Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. BMJ 1978;2:85–8.
Utsunomiya J, Iwama T, Imajo M,et al. Total colectomy, mucosal proctectomy, and ileoanal anastomosis. Dis Colon Rectum 1980;23:459–66.
Nicholls RJ, Pezim ME. Restorative proctocolectomy with ileal reservoir for ulcerative colitis and familial adenomatous polyposos: a comparison of three reservoir designs. Br J Sug 1985;72:470–4.
Ramos R, Bode WE. A simple technique for construction of a J-pouch. Dis Colon Rectum 1988;31:87–9.
Liljeqvist L, Lindquist K, Ljungdahl I. Alterations in Ileoanal pouch technique, 1980 to 1987: complications and functional outcome. Dis Colon Rectum 1988;31:929–38.
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.
Williams NS. Stapling technique for pouch-anal anastomosis without the need for purse-string sutures. Br J Surg 1989;76:348–9.
Kmiot WA, Keighley MR. Totally stapled abdominal restorative proctocolectomy. Br J Surg 1989;76:961–4.
Lavery IC, Tuckson WB, Easley KA. Internal anal sphincter ileal pouch-anal anastomosis without mucosal proctectomy. Dis Colon Rectum 1989;32:950–3.
Lavery IC, Tuckson WV, Fazio VW, Oakley JR, Church JM, Milsom JW. Pouch surgery—the importance of the transitional zone. Can J Gastroenterol 1990;4:428–31.
Tuckson W, Lavery I, Fazio V, Oakley J, Church J, Milsom J. Manometric and functional comparison of ileal pouch anal anastomosis with and without anal manipulation. Am J Surg 1991;161:90–6.
Ambroze WL, Pemberton JH, Dozios RR, Carpenter HA, O'Rourke JS, Ilstrup DM. The histological pattern and pathological involvement of the anal transition zone in patients with ulcerative colitis. Gastroenterology 1993;104:514–8.
Wexner SD, Wong WD, Rothenberger DA, Goldberg SM. The ileoanal reservoir. Am J Surg 1990;159:178–85.
Baker WN, Glass RE, Ritchie JK, Aylett SO. Cancer of the rectum following colectomy and ileorectal anastomosis for ulcerative colitis. Br J Surg 1978;65:862–8.
Grundfest SF, Fazio V, Weiss RA,et al. The risk of cancer following colectomy and ileorectal anastomosis for extensive mucosal ulcerative colitis. Ann Surg 1981;193:9–14.
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.
Deasy JM, Quirke P, Dixon M, Lagopoulos M, Johnston D. The surgical importance of the anal transitional zone in ulcerative colitis. Br J Surg 1987;74:522–4.
King DW, Lubowski DZ, Cook TA. Anal canal mucosa in restorative proctocolectomy for ulcerative colitis. Br J Surg 1989;76:970–2.
Curran FT, Sutton TD, Jass JR, Hill GL. Ulcerative colitis in the anal canal of patients undergoing restorative proctocolectomy. Aust N Z J Surg 1991;61:821–4.
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Read at the meeting of The American Society of Colon and Rectal Surgeons, Orlando, Florida, May 8 to 13, 1994.
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Lavery, I.C., Sirimarco, M.T., Ziv, Y. et al. Anal canal inflammation after ileal pouch-anal anastomosis. Dis Colon Rectum 38, 803–806 (1995). https://doi.org/10.1007/BF02049836
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DOI: https://doi.org/10.1007/BF02049836