Ileal pouch anal function after endoanal mucosectomy and handsewn ileoanal anastomosis compared with stapled anastomosis without mucosectomy
Hallgren, T.A.; Fasth, S.B.; Oresland, T.O.; Hultén, L.A.
European Journal of Surgery 161(12): 915-921
1995
ISSN/ISBN: 1102-4151 PMID: 8775636 Document Number: 450787
Objective: To compare manovolumetric results and functional outcome after restorative proctocolectomy with either mucosal proctectomy and handsewn pouch-anal anastomosis or stapling. Design: Prospective randomized study. Setting: University hospital, Sweden. Subjects: 80 Consecutive patients undergoing restorative proctocolectomy. Interventions: 37 patients were randomized to have mucosectomy and a handsewn anastomosis and 43 patients to have a stapled anastomosis. Main outcome measures: Comparisons of anal sphincter function and clinical outcome in terms of continence and overall functional score between the two groups of patients. Results: There was persistent reduction in anal resting tone at one year amounting to 29% in the handsewn group and to 21% in the stapled group (p lt 0.001 compared with preoperative in both groups). Daytime continence was similar, but patients with stapled anastomoses experienced less soiling during sleep, especially in the early postoperative period (5/43,12% compared with 15/33, 45% at one month, p lt 0.001). The arbitrary overall functional score was, however, similar in both groups. Conclusion: Handsewn and stapled ileal pouch-anal anastomoses result in similar postoperative anal sphincter impairment and overall clinical outcome.