Efficacy of the straight endorectal pull-through in the management of familial adenomatous polyposis--a 16-year experience

Laparoscopic-assisted ileal pouch-rectal muscle sheath anastomosis for the treatment of familial adenomatous polyposis

PURPOSE

Familial adenomatous polyposis (FAP) is a colorectal disease treated by proctocolectomy. While ileal pouch-anal anastomosis preserves the anus, defecation dysfunction and incontinence can occur. We herein report the results of an improved laparoscopic-assisted ileal pouch-rectal muscle sheath anastomosis after total proctocolectomy which preserves anal function, and compare the results with ileal pouch-anal anastomosis.

METHODS

A total of 22 patients with FAP were randomized to receive either ileal pouch-anal anastomosis (n = 11) or ileal pouch-rectal muscle sheath anastomosis (n = 11) after total proctocolectomy. Operation time, intraoperative blood loss, postoperative complications, length of hospitalization and postoperative anal pressure, defecation frequency, and quality of life were recorded and compared between the two groups.

RESULTS

All patients completed a minimum follow-up of 1 year. At the 1 year after the surgery, the daytime defecation frequency was 4.64 ± 0.92 times/day in the ileal pouch-rectal muscle sheath anastomosis group and 6.55 ± 1.13 times/day in the ileal pouch-anal anastomosis group (P = 0.004). Resting anal pressure, maximum squeeze pressure, and average number of daytime defecations in the ileal pouch-rectal muscle sheath group were all better than in the ileal pouch-anal anastomosis group (all, P < 0.05)

CONCLUSIONS

Ileal pouch-rectal muscle sheath anastomosis is associated with better anal function than ileal pouch-anal anastomosis.

Restorative proctocolectomy and ileal pouch-anal anastomosis in children

PURPOSE

This study was designed to evaluate the results of restorative proctocolectomy with distal rectal mucosectomy and ileal pouch-anal anastomosis in children.

METHODS

This study is a retrospective review of 100 consecutively referred children (<18 years old) who underwent reconstruction with a J-pouch of ileum and preservation of the transitional anorectal epithelium by the same two-surgeon team. Temporary diverting ileostomy was used. The main outcome measures were daytime and nocturnal fecal continence, bowel movements per day, and complications including pouchitis, ileoanal stricture, or postoperative small-bowel obstruction.

RESULTS

Average age of the 100 children (48 males/52 females) was 13.2 years (range, 2.95-17.99). All 25 children with familial adenomatous polyposis had proctocolectomy and reconstruction performed simultaneously. Of 75 children with ulcerative colitis, 50 (67%) had their colectomy followed by reconstruction after an interval ranging from 2 months to 4.4 years. Median postoperative follow-up was 2.6 years. Daytime fecal continence was achieved in 98 children, although 4 reported rare accidents. Nighttime continence was achieved in 93 children, of whom 14 reported rare accidents. The average frequency of bowel movements was 5.43/day (+/-2.22). Only one child with polyposis had pouchitis. Of 75 children with ulcerative colitis, 35 had symptoms consistent with pouchitis; of these 35 children, 10 required prolonged treatment. The most frequent postoperative complication was ileoanal stricture requiring operative dilatation and/or anoplasty (18 children). Bowel obstruction requiring surgery occurred in 18 children. One child eventually required pouchectomy for probable Crohn's disease.

CONCLUSIONS

Excellent results can be achieved with restorative proctocolectomy in children with respect to fecal continence and stool frequency. However, with ulcerative colitis, a substantial risk of pouchitis remains.