ILEOANAL POUCHES - IS MUCOSECTOMY UNNECESSARY

The current literature indicates that a stapled ileoanal anastomosis is a safe procedure which may lead to a quicker and more easily achievable anastomosis. In our own series, there has been an overall decrease in the leak rate using a stapled anastomosis. The risk of carcinoma in using this type of technique is theoretically greater if an entire mucosectomy has not been performed. However, the only reported cases of carcinoma associated with this procedure have been in those patients who have had a supposed total mucosectomy. Because of the theoretical potential of the development of carcinoma in the residual anal mucosa, it is important to recommend that a stapled anastomosis be carried out only in selected individuals showing no evidence of dysplasia and in those patients with familial polyposis. If a stapled anastomosis is to be used, careful long term follow-up is required to ensure that, if dysplasia occurs in the residual anorectal mucosa, it will be diagnosed at an early stage.