The Ileo Neo-Rectal Anastomosis, a restorative procedure for ulcerative colitis and familial adenomatous polyposis without a pouch

Laarhoven, Cees J. H. M. van; Andriesse, Gunnar I.; Schipper, Marguérite E.I.; Akkermans, L.M.A.; Vroonhoven, T J van; Gooszen, Hein G.

doi:10.1016/s0016-5085(00)82552-4

Cited by 6 publications

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“…Ideas on resection of diseased colonic mucosa and small bowel mucosa transplantation are not new [18,19]. Several authors have presented experimental studies on replacement of rectal mucosa by small bowel mucosa [12–16].…”

Section: Discussionmentioning

confidence: 99%

The ileo neorectal anastomosis: an experimental study on development of the surgical technique and theoretical background

et al. 2001

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Objective The keystones of surgical treatment of ulcerative colitis and familial adenomatous polyposis are resection of the diseased colon with either an ileostomy or restoration of oro-anal continuity with an ileo-anal pouch. The ileo pouch anal anastomosis however, has a 15±35% pouch-related complication rate, 10% failure rate and is accompanied by an unpredictable functional outcome. In order to reduce these unfavourable rates and to improve functional results an alternative surgical technique, the ileo neorectal anastomosis (INRA), was developed experimentally. Materials and methodsIn an experimental study 12 Yorkshire-Dutch landpigs had a subtotal colectomy and rectal mucosectomy. Subsequently a vascularized ileal mucosa sling was created and transposed on to the denuded rectal muscular cuff in eight. In another four animals a non-vascularized mucosa sling was transposed. The covering ileostomy was closed after 3 weeks. Repeated endoscopies, histological examinations of mucosal biopsies and rectal compliance measurements were carried out to evaluate the functional result of the neorectum. ResultsThe surgical procedure of the INRA was technically successful in this animal study. Repeated endoscopy and histology showed complete ileal mucosa ingrowth in the neorectum without severe ®brosis in the group of animals with a vascularized sling. At follow up after 1 year no colonic metaplasia had occurred. Measurements of the neorectal reservoirs in the group of animals with a vascularized INRA procedure showed a median`maximum tolerated volume' of 338 ml (range 300±410 ml). ConclusionThe INRA is technically feasible and reproducible. The histologically proven survival of the vascularized ileal mucosa and development of a compliant neorectal reservoir make the INRA an interesting alternative restorative procedure. Avoidance of the pouchrelated complications of the ileo pouch anal anastomosis by this procedure might herald a new era of restorative surgery.

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Section: Discussionmentioning

confidence: 99%

The ileo neorectal anastomosis: an experimental study on development of the surgical technique and theoretical background

et al. 2001

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“…With only mild stenosis as a “reservoir related” complication, this goal has been achieved 24. The next two major objects are to preserve anal sphincter function and to create a compliant reservoir to ensure full continence, the ability to defer defecation, and an acceptable stool frequency.…”

Section: Discussionmentioning

confidence: 99%

“…After successful experiments with INRA in pigs,23 a pilot study in patients was initiated. The initial clinical results of this study have been described recently 24. We now report in more detail on the results of gastrointestinal motility tests after INRA over a follow up period of one year.…”

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confidence: 83%

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Functional results and visceral perception after ileo neo-rectal anastomosis in patients: a pilot study

Andriesse

Gooszen

Schipper

et al. 2001

Gut

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26 (14-40) (p=0.02)) and the rectal threshold for TENS displayed a similar tendency. All patients displayed a low grade chronic inflammatory infiltrate in neorectal biopsy samples before closure of the ileostomy, with no change during follow up. Conclusions-The technique of INRA provides a safe alternative for restorative surgery. Stool frequency after INRA improves with time and seems to be related to decreasing sensitivity and not to histopathological changes in the neorectum. Furthermore, after the INRA procedure, all patients reported full continence. (Gut 2001;48:683-689)

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“…RPC was performed by three surgeons in the Radboud University Nijmegen Medical Centre and INRA was carried out by two dedicated surgeons from the University Medical Centre Utrecht and one from the St Elisabeth Hospital Tilburg. INRA was performed after colectomy as described by van Laarhoven et al [7,10]. RPC was performed as described by Nicholls and Pezim [16].…”

Section: Patient Populationmentioning

confidence: 99%

Evaluation of long‐term function, complications, quality of life and health status after restorative proctocolectomy with ileo neo rectal and with ileal pouch anal anastomosis for ulcerative colitis

et al. 2013

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The Ileo Neo-Rectal Anastomosis, a restorative procedure for ulcerative colitis and familial adenomatous polyposis without a pouch

Cited by 6 publications

References 0 publications

The ileo neorectal anastomosis: an experimental study on development of the surgical technique and theoretical background

The ileo neorectal anastomosis: an experimental study on development of the surgical technique and theoretical background

Functional results and visceral perception after ileo neo-rectal anastomosis in patients: a pilot study

Evaluation of long‐term function, complications, quality of life and health status after restorative proctocolectomy with ileo neo rectal and with ileal pouch anal anastomosis for ulcerative colitis

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