Straight ileoanal anastomosis with multiple ileal myotomies as an alternative to pelvic pouch

Abstract

1) SIAM can be an alternative to pelvic pouch in patients who have undergone restorative proctocolectomy when the construction of the pouch is not feasible. 2) The functional result observed after SIAM has been shown to be similar to that observed after pouch construction.

Outcome after ileal pouch‐anal anastomosis in ulcerative colitis patients: experience during a 27‐year period

“…The cause may be due to sectioning of the sympathetic and parasympathetic pelvic nerve fibres that innervate the internal sphincter during proctectomy . In literature, it is still debate whether handsewn IPAA leads to a drop in basal anal sphincter tone similar or greater than that stapled IPAA . In our experience, the manometric results do not show significant differences among different IPAA techniques on the maximum basal pressure, the length of the high pressure zone and the maximum voluntary contraction.…”

Techniques of ileoanal anastomosis: historical evolution, refinements, and current approaches

“…Still others applied the U-shaped reservoir used in the creation of a Kock pouch but without the valve. Further refinements such as myotomies of the ileum were suggested by Accarpio et al [16] Pescatori and Parks [17] and Tonelli et al [18], but these modifications were never adopted by others.…”

Secondary reconstruction of an ileal reservoir in patients with failed straight ileoanal pull-through: report of two cases

“…Not surprisingly, therefore, severe anal excoriation and fecal incontinence, especially nocturnal [4], are common in these patients. In these cases, several options exist including permanent end ileostomy, balloon dilatation of the neorectum, isoperistaltic side-to-side ileal pouch construction [5], longitudinal strip myectomy with ileoanal anastomosis [6], multiple ileal myotomies as an alternative to pelvic pouch [7], inverted U-pouch construction [8], or secondary construction of an ileoanal anastomosis [9]. Few reports describe either the technique or results of secondary ileoanal reservoir construction after failed straight ileoanal anastomosis.…”