Randomized Prospective Trial Comparing Ileal Pouch-Anal Anastomosis Performed by Excising the Anal Mucosa to Ileal Pouch-Anal Anastomosis Performed by Preserving the Anal Mucosa

Abstract

ObjectiveThe purpose of the study is to compare the results of ileal pouch-anal anastomosis (IPM) in patients in whom the anal mucosa is excised by handsewn techniques to those in whom the mucosa is preserved using stapling techniques. Summary Background DataIleal pouch-anal anastomosis is the operation of choice for patients with chronic ulcerative colitis requiring proctocolectomy. Controversy exists over whether preserving the transitional mucosa of the anal canal improves outcomes. MethodsForty-one patients (23 men, 18 women) were randomized to either endorectal mucosectomy and handsewn IPM or to double-stapled IPM, which spared the anal transition zone. All patients were diverted for 2 to 3 months. Nine patients were excluded. Preoperative functional status was assessed by questionnaire and anal manometry. Twenty-four patients underwent more extensive physiologic evaluation, including scintigraphic anopouch angle studies and pudendal nerve terminal motor latency a mean of 6 months after surgery. Quality of life similarly was estimated before surgery and after surgery. Univariate analysis using Wilcoxon test was used to assess differences between groups. ResultsThe two groups were identical demographically. Overall outcomes in both groups were good. Thirty-three percent of patients who underwent the handsewn technique and 35% of patients who underwent the double-stapled technique experienced a postoperative 666

Postoperative complications after stapled and hand‐sewn ileal pouch‐anal anastomosis for familial adenomatous polyposis: A multicenter study

“…Previous studies reported better fecal continence after stapled IPAA without mucosectomy compared with hand‐sewn IPAA with mucosectomy, possibly as a result of reduced anal canal manipulation and preservation of ATZ 5, 7, 8, 9, 10. In contrast, the studies by Remzi et al.…”

“…Previous studies have reported several pros and cons on these two anastomotic techniques. Stapled IPAA is the simpler type of anastomosis with shorter length of operation and better fecal continence possibly as a result of omission of mucosectomy and preservation of the anal transitional zone (ATZ) 5, 7, 8, 9, 10. In contrast, hand‐sewn IPAA with mucosectomy can reduce a substantial risk for developing adenomas at the anastomotic site 11…”

“…Some studies found higher incidence of septic complications, fistula and anastomotic stricture after hand‐sewn IPAA,5, 9, 12 whereas other studies showed a trend toward higher incidence of overall complications and stricture after stapled IPAA 13, 14. Importantly, most of the previous studies included patients with ulcerative colitis (UC) rather than patients with FAP 5, 8, 14, 15 although the complication rates were different between such patients 5, 8, 14, 15. Furthermore, none of the studies used objective criteria such as the Clavien‐Dindo classification for stratifying the complications 5, 8, 9, 12, 13, 14, 15.…”

“…Importantly, most of the previous studies included patients with ulcerative colitis (UC) rather than patients with FAP 5, 8, 14, 15 although the complication rates were different between such patients 5, 8, 14, 15. Furthermore, none of the studies used objective criteria such as the Clavien‐Dindo classification for stratifying the complications 5, 8, 9, 12, 13, 14, 15. These limitations could explain inconsistent results in the previous studies, and we need evidence that focuses on patients with FAP with the use of objective criteria for assessing complications.…”

Risk Factors for Ileoanal J Pouch-Related Septic Complications in Ulcerative Colitis and Familial Adenomatous Polyposis

“…9,16,20 Various studies have even shown these variations to be influencing factors for PRSC. 12,30,31 Our study design provided several advantages. Data about the preclinical status and data obtained from direct contact with the patients at each of the follow-up consultations were entered into a clinical registry and documented prospectively.…”