Functional outcome after pouch-anal reconstruction with primary and secondary mucosectomy for patients with familial adenomatous polyposis (FAP)
- 21 Downloads
Restorative proctocolectomy and ileal pouch-anal reconstruction is the surgical standard for the majority of patients with familial adenomatous polyposis (FAP). The pouch-anal anastomosis may be performed handsewn after primary mucosectomy or by double stapling. Better functional results favour the latter; however, higher rates of remaining rectal mucosa with adenomas often necessitate secondary mucosectomy. Data on functional outcome after secondary mucosectomy is scarce. The aim of the study was to analyse whether patients who undergo secondary mucosectomy maintain their functional benefits compared to patients with primary mucosectomy.
Patients and methods
Twenty patients after secondary mucosectomy and 31 patients after primary mucosectomy were compared with respect to their functional outcome, using the MSKCC score, the Wexner score and ano-rectal physiology testing.
The MSKCC global score and the Wexner score showed a non-significant trend towards slightly better results after secondary mucosectomy (63.1 vs. 56.6, p = 0.0188 and 9.5 vs. 11, p = 0.3780). Patients after secondary mucosectomy also showed a tendency towards less bowel movements per 24 h (7 (range 4–11) vs. 8.5 (range 3–20), p = 0.1518). Resting pressures were slightly higher after secondary (44 vs. 39.6 mmHg, p = 0.4545) and squeeze pressures slightly higher after primary mucosectomy (87.6 vs. 81.2 mmHg, p = 0.6126). However, the results did not reach statistical significance.
The results of this study cannot ultimately resolve the controversy concerning handsewn versus stapled ileal pouch-anal anastomosis. Our results suggest a trend towards better functional results after stapled anastomosis with secondary mucosectomy.
KeywordsFAP IPAA Primary versus secondary mucosectomy
P.G.: primary author of manuscript, conceptual development of study, acquisition of data, analysis and interpretation of results. I.T.: acquisition of data, analysis and interpretation of results. U.H.: critical review of study design, statistical analysis of data, interpretation of data, interpretation of results, statistical counselling of study. M.K.: conceptual development of study, analysis and interpretation of results, critical review of manuscript and possible impact on clinical management.
Compliance with ethical standards
Conflict of interest
All authors declare that they had no conflict of interest concerning the presented study.
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 14.Reilly WT, Pemberton JH, Wolff BG, Nivatvongs S, Devine RM, Litchy WJ, McIntyre PB (1997) 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. Ann Surg 225:666–677CrossRefGoogle Scholar
- 17.Remzi FH, Fazio VW, Delaney CP, Preen M, Ormsby A, Bast J, OʼRiordain MG, Strong SA, Church JM, Petras RE, Gramlich T, Lavery IC (2003) Dysplasia of the anal transitional zone after ileal pouch-anal anastomosis. Results of prospective evaluation after a minimum of ten years. Dis Colon Rectum 46:6–13CrossRefGoogle Scholar
- 18.von Roon AC, Will OCC, Man RF, Neale KF, Phillips RKS, Nicholls RJ, Clark SK, Tekkis PP (2011) Mucosectomy with handsewn anastomosis reduces the risk of adenoma formation in the anorectal segment after restorative proctocolectomy for familial adenomatous polyposis. Ann Surg 253(2):314–317CrossRefGoogle Scholar