Abstract
Regeneration of rectal mucosa after rectal mucosectomy and ileoanal anastomosis (IAA) could jeopardize the long-term safety of the procedure. The aim of this study was to determine if rectal mucosal regeneration occurred after IAA. Pathologic specimens of the IAA and surrounding rectal muscular cuff were obtained from 29 patients who had required IAA excision 17±2 months (mean±SEM, range, 2 to 48 months) following construction. Multiple (≥6) coronal and sagittal sections of each specimen were made and examined histologically. The rectal muscle cuff was bound to ileal serosa by dense fibrous tissue. Small islets of residual rectal mucosa were identified between the denuded rectal cuff and the ileal pull-through in four patients (14 percent) and at the ileoanal anastomosis in two patients (7 percent). Active rectal muscosal disease, dysplasia, or reeplithelialization of the denuded rectal muscle were not seen. It is concluded that small islets of rectal mucosa may remain after IAA. Up to four years after IAA, however, no evidence of rectal mucosal regeneration could be documented.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ravitch MM, Sabiston DC Jr. Anal ileostomy with preservation of the sphincter. Surg Gynecol Obstet 1947;84:1095–9.
Ravitch MM, Handelsman JC. One stage resection of the entire colon and rectum for ulcerative colitis and polypoid adenomatosis. Bull Johns Hopkins Hosp 1951;88:59–82.
Best RR. Anastomosis of the ileum to the lower part of the rectum and anus. Arch Surg 1948;57:276–85.
Martin LW, LeCoultre C, Schubert WK. Total colectomy and mucosal proctectomy with preservation of continence in ulcerative colitis. Ann Surg 1977;186:477–9.
Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. Br Med J 1978;2:85–8.
Telander RL, Perrault J. Colectomy with rectal mucosectomy and ileoanal anastomosis in young patients: its use for ulcerative colitis and familial polyposis. Arch Surg 1981;116:623–9.
Utsunomiya J, Iwama T. The J ileal pouch-anal anastomosis: the Japanese experience. In: Dozois RR, ed. Alternatives to conventional ileostomy. Chicago: Year Book Medical Publishers, 1985:371–83.
Metcalf A, Beart RW Jr, Dozois RR, Kelly KA, Wolff BG. Ileal J pouch-anal anastomosis: clinical outcome. Ann Surg 1985;202:735–9.
Wong WD, Rothenberger DA, Goldberg SM. Ileonal pouch procedures. Curr Probl Surg 1985;22:1–78.
Nicholls RJ, Moskowitz RL, Sheperd NA. Restorative proctocolectomy with ileal reservoir. Br J Surg 1985;72(suppl):S76–9.
Heppell J, Weiland LH, Perrault J, Pemberton JH, Telander RL, Beart RW Jr. Fate of the rectal mucosa after rectal mucosectomy and ileoanal anastomosis. Dis Colon Rectum 1983;26:768–71.
Ballantyne GH, Pemberton JH, Beart RW Jr, Wolff BG, Dozois RR. Ileal “J” pouch-anal anastomosis: current technique. Dis Colon Rectum 1985;28:197–202.
Goligher JC. Eversion technique for distal mucosal proctectomy in ulcerative colitis: a preliminary report. Br J Surg 1984;71:26–8.
Kelly KA. Ileal pouch-anal anastomosis after proctocolectomy. Surg Rounds 1985;8:48–57.
Burnham WR, Lennard-Jones JE, Brooke BN. Sexual problems among married ileostomists. Gut 1977;18:673–7.
Bauer JJ, Gelernt IM, Salky B, Kreel I. Sexual dysfunction following proctocolectomy for benign disease of the colon and rectum. Ann Surg 1983;197:363–7.
Watson LC, Friedman HI, Griffin DG, Norton LW, Mellick PW. Small bowel neomucosa. J Surg Res 1980;28:280–91.
Hampton JM. Rectal mucosal stripping: a technique for preservation of the rectum after total colectomy for chronic ulcerative colitis. Dis Colon Rectum 1976;19:133–5.
Devroede GJ, Taylor WF, Sauer WG, Jackman RJ, Stickler GB, Cancer risk and life expectancy of children with ulcerative colitis. N Engl J Med 1971;285:17–21.
Katzka I, Brody RS, Morris E, Katz S. Assessment of colorectal cancer risk in patients with ulcerative colitis: experience from a private practice. Gastroenterology 1983;85:22–9.
Yardley JH, Ransohoff DF, Riddell RH, Goldman H. Cancer in inflammatory bowel disease: how serious is the problem and what should be done about it? (editorial) Gastroenterology 1983;85:197–200.
Parc R, Levy E, Frileux P, Loygue J. Current results: ileorectal anastomosis after total abdominal colectomy for ulcerative colitis. In: Dozois RR, ed. Alternatives to conventional ileostomy. Chicago: Year Book Medical Publishers, 1985:81–99.
Martin LW LeCoultre C. Technical considerations in performing total colectomy and Soave endorectal anastomosis for ulcerative colitis. J Pediatr Surg 1978;13:762–4.
Fonkalsrud EW. Endorectal ileal pullthrough with ileal reservoir for ulcerative colitis and polyposis. Am J Surg 1982;144:81–7.
Hodgson WJ, Finkelstein JL, Woodriffe P, Aufses AH. Continent anal ileostomy with mucosal proctectomy: a bloodless technique using a surgical ultrasonic aspirator in dogs. Br J Surg 1979;66:857–60.
Heimann TM, Kurtz RJ, Aufses AH Jr. Ultrasonic fragmentation: a new technique for mucosal proctectomy. Arch Surg 1985;120:1200–3.
Heimann TM, Kurtz RJ, Shen-Schwarz S, Aufses AH Jr. Ultrasonic mucosal proctectomy without endorectal pull-through. Dis Colon Rectum 1985;28:336–40.
Heimann TM, Kurtz RJ, Shen S, Aufses AH Jr. Mucosal proctectomy using an ultrasonic scalpel. Am J Surg 1984;147:803–6.
Kojima Y, Sanada Y, Fonkalsrud EW. Evaluation of techniques for chemical debridement of colonic mucosa. Surg Gynecol Obstet 1982;155:849–54.
Fujiwara T, Kawarasaki H, Fonkalsrud EW. Endorectal ileal pullthrough procedure after chemical debridement of the rectal mucosa. Surg Gynecol Obstet 1984;158:437–42.
Author information
Authors and Affiliations
Additional information
Read in part at the meeting of the American Society of Colon and Rectal Surgeons, Houston, Texas, May 11 to 15, 1986.
About this article
Cite this article
O'Connell, P.R., Pemberton, J.H., Weiland, L.H. et al. Does rectal mucosa regenerate after ileonal anastomosis?. Dis Colon Rectum 30, 1–5 (1987). https://doi.org/10.1007/BF02556908
Issue Date:
DOI: https://doi.org/10.1007/BF02556908