International Journal of Colorectal Disease

, Volume 34, Issue 7, pp 1317–1323 | Cite as

Postoperative functional outcomes and complications of partially intraanal canal anastomosis in stapled ileal pouch anal anastomosis for ulcerative colitis

  • Akira SugitaEmail author
  • Kazutaka Koganei
  • Kenji Tatsumi
  • Ryo Futatsuki
  • Hirosuke Kuroki
  • Kyoko Yamada
  • Hideaki Kimura
  • Tsuneo Fukushima
Original Article



For ulcerative colitis (UC), stapled ileal pouch anal anastomosis (IPAA) reportedly results in better bowel function than does IPAA with mucosectomy. However, a potential cancer risk in the remnant mucosa has been observed. The clinical results of IPAA by double stapling technique (DS-IPAA) in which the anastomotic line was on the dentate line at posterior wall and the top of anal canal at anterior wall (“Partially intraanal canal anastomosis”: PICA) to reduce the remnant mucosa were evaluated.


Clinical results of PICA were retrospectively compared with those by DS-IPAA with anastomosis at above the anal canal on 1 year after open surgery. Of 211 UC cases that underwent DS-IPAA, 146 cases (69%) with PICA who were confirmed by the squamous epithelium on the posterior part of the distal donuts were included. Sixty-five cases with anastomosis above the anal canal were evaluated as the control. One stage surgery underwent in 95% of PICA and 93% of control.


One year after surgery, each group had six bowel movements daily. Nighttime evacuation was found in 16% of PICA and in 20% of control. Soiling was found in 1% of PICA and 4.8% of control. After one stage operation, anastomotic leakage that needed ileostomy was observed in 0.7% of PICA and 3% of control.


Partially intraanal canal anastomosis (PICA) can reduce anal canal mucosa with the same postoperative bowel function and complication rate as DS-IPAA above the anal canal. This procedure may be feasible for UC patients who can tolerate this procedure in terms of decreasing postoperative cancer risk.


Ulcerative colitis Stapled ileal pouch anal anastomosis Partially intraanal canal anastomosis Postoperative bowel function Postoperative complications 


Funding information

This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Akira Sugita
    • 1
    Email author
  • Kazutaka Koganei
    • 1
  • Kenji Tatsumi
    • 1
  • Ryo Futatsuki
    • 1
  • Hirosuke Kuroki
    • 1
  • Kyoko Yamada
    • 1
  • Hideaki Kimura
    • 2
  • Tsuneo Fukushima
    • 3
  1. 1.Department of Inflammatory Bowel DiseaseYokohama Municipal Citizen’s HospitalYokohamaJapan
  2. 2.Inflammatory Bowel Disease CenterYokohama City University Medical CenterYokohamaJapan
  3. 3.Matsushima ClinicYokohamaJapan

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