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

被引:127
作者
Reilly, WT
Pemberton, JH
Wolff, BG
Nivatvongs, S
Devine, RM
Litchy, WJ
McIntyre, PB
机构
[1] MAYO CLIN & MAYO FDN, MAYO MED SCH, DIV COLON & RECTAL SURG, ROCHESTER, MN 55905 USA
[2] EYVAZZADEH COLON & RECTAL CTR, BETHLEHEM, PA USA
[3] RIVERSIDE MED CTR, DEPT NEUROL, MINNEAPOLIS, MN USA
[4] CAMP HILL MED COMPLEX, GI UNIT, HALIFAX, NS, CANADA
关键词
D O I
10.1097/00000658-199706000-00004
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective The purpose of the study is to compare the results of ileal pouch-anal anastomosis (IPAA) 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 Data Ileal 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. Methods Forty-one patients (23 men, 18 women) were randomized to either endorectal mucosectomy and handsewn IPAA or to double-stapled IPAA, 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. Results The 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 complication. Resting anal canal pressures were higher in the patients who underwent the stapled technique, but other physiologic parameters were similar between groups. Night time fecal incontinence occurred less frequently in the stapled group but not significantly. The number of stools per 24 hours decreased from preoperative values in both groups. After IPAA, quality of life improved promptly in both groups. Conclusions Stapled IPAA, which preserves the mucosa of the anal transition zone, confers no apparent early advantage in terms of decreased steal frequency or fewer episodes of fecal incontinence compared to handsewn IPAA, which excises the mucosa, Higher resting pressures in the stapled group coupled with a trend toward less night-time incontinence, however, may portend better function in the stapled group over time. Both operations are safe and result in rapid and profound improvement in quality of life.
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页码:666 / 676
页数:11
相关论文
共 43 条
[1]   THE HISTOLOGICAL PATTERN AND PATHOLOGICAL INVOLVEMENT OF THE ANAL TRANSITION ZONE IN PATIENTS WITH ULCERATIVE-COLITIS [J].
AMBROZE, WL ;
PEMBERTON, JH ;
DOZOIS, RR ;
CARPENTER, HA ;
OROURKE, JS ;
ILSTRUP, DM .
GASTROENTEROLOGY, 1993, 104 (02) :514-518
[2]   SCINTIGRAPHIC ASSESSMENT OF THE ANORECTAL ANGLE IN HEALTH AND AFTER ILEAL POUCH-ANAL ANASTOMOSIS [J].
BARKEL, DC ;
PEMBERTON, JH ;
PEZIM, ME ;
PHILLIPS, SF ;
KELLY, KA ;
BROWN, ML .
ANNALS OF SURGERY, 1988, 208 (01) :42-49
[3]   MECHANISMS OF RECTAL CONTINENCE - LESSONS FROM THE ILEOANAL PROCEDURE [J].
BEART, RW ;
DOZOIS, RR ;
WOLFF, BG ;
PEMBERTON, JH .
AMERICAN JOURNAL OF SURGERY, 1985, 149 (01) :31-34
[4]   ILEAL POUCH-ANAL ANASTOMOSIS - A SINGLE SURGEONS EXPERIENCE WITH 100 CONSECUTIVE CASES [J].
BECKER, JM ;
RAYMOND, JL .
ANNALS OF SURGERY, 1986, 204 (04) :375-383
[5]   SENSORY NERVE-ENDINGS AND SENSATION IN THE ANAL REGION OF MAN [J].
DUTHIE, HL ;
GAIRNS, FW .
BRITISH JOURNAL OF SURGERY, 1960, 47 (206) :585-595
[6]   STRAIGHT ILEOANAL ANASTOMOSIS WITH PRESERVED ANAL MUCOSA FOR ULCERATIVE-COLITIS AND FAMILIAL POLYPOSIS [J].
EMBLEM, R ;
BERGAN, A ;
LARSEN, S .
SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY, 1988, 23 (08) :913-919
[7]   PRESERVATION OF CONTINENCE AFTER ILEOANAL ANASTOMOSIS BY THE COORDINATION OF ILEAL POUCH AND ANAL-CANAL MOTOR-ACTIVITY [J].
FERRARA, A ;
PEMBERTON, JH ;
HANSON, RB .
AMERICAN JOURNAL OF SURGERY, 1992, 163 (01) :83-89
[8]   MOTOR DETERMINANTS OF INCONTINENCE AFTER ILEAL POUCH-ANAL ANASTOMOSIS [J].
FERRARA, A ;
PEMBERTON, JH ;
GROTZ, RL ;
HANSON, RB .
BRITISH JOURNAL OF SURGERY, 1994, 81 (02) :285-288
[9]   FUNCTIONAL ASSESSMENT OF ILEAL POUCH-ANAL ANASTOMOTIC TECHNIQUES [J].
GEMLO, BT ;
BELMONTE, C ;
WILTZ, O ;
MADOFF, RD .
AMERICAN JOURNAL OF SURGERY, 1995, 169 (01) :137-142
[10]   Low malignant potential of the double-stapled ileal pouch-anal anastomosis [J].
Haray, PN ;
Amarnath, B ;
Weiss, EG ;
Nogueras, JJ ;
Wexner, SD .
BRITISH JOURNAL OF SURGERY, 1996, 83 (10) :1406-1406