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

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Aim

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.

Methods

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.

Results

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.

Conclusion

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.

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References

  1. Sugita A, Fukushima H, Harada H et al (1993) Comparison of postoperative results between Leal-pouch anal anastomosis and stapled ileal pouch-anal anastomosis for ulcerative colitis. Dis Colon Rectum 36(4):p2

    Google Scholar 

  2. Lovegrove RE, Constantinides VA, Heriot AG, Athanasiou T, Darzi A, Remzi FH, Nicholls RJ, Fazio VW, Tekkis PP (2006) A comparison of hand-sewn versus stapled ileal pouch anal anastomosis(IPAA) following proctocolectomy-a meta-analysis of 4183 patients. Ann Surg 244:18–26

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kariv R, Remzi FH, Bennett AE et al (2010) Preoperative colorectal neoplasia increase risk for pouch neoplasia in patients with restorative proctocolectomy. Gastroenterology 139:806–812

    Article  PubMed  Google Scholar 

  4. Shafik A (1979) A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. VIII Levator Hiatus and tunnel: anatomy and function. Dis Colon Rectum 22:539–549

    Article  CAS  PubMed  Google Scholar 

  5. Martin LW, LeCouitr C, Schubert WK (1977) Total colectomy and mucosal proctectomy with preservation of continence in ulcerative colitis. Ann Surg 186:477–480

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Parks AG, Nicholls RJ (1980) Proctectomy with ileal reservoir and anal anastomosis. Br J Surg 67:533–538

    Article  CAS  PubMed  Google Scholar 

  7. Beart RW Jr, Dozois RR, Kelly KA (1982) Ileoanal anastomosis in the adult. Surg Gynecol Obstet 154:826–829

    PubMed  Google Scholar 

  8. Martin LW, Fischer JE (1982) Preservation of anorectal continence following total colectomy. Ann Surg 196:700–704

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Holdsworth PJ, Jhonston D (1988) Anal sensation after restorative proctocolectomy for ulcerative colitis. Br J Surg 75:993–996

    Article  CAS  PubMed  Google Scholar 

  10. Lavery IC, Tuekson WB, Eusley KA (1989) Internal anal sphincter function after total abdominal colectomy and stapled ileal pouch anal anastomosis without mucosal proctectomy. Dis Colon Rectum 32:950–953

    Article  CAS  PubMed  Google Scholar 

  11. Keighley MRG, Winslet MC, Yoshioka K et al (1987) Discrimination is not impaired by exsion of the anal transitional zone after restorative proctocolectomy. Br J Surg 74:1118–1121

    Article  CAS  PubMed  Google Scholar 

  12. Shivestri MT, Hurst RD, Rubin MA et al (2008) Chronic inflammatory changes in the anal transition zone after stapled ileal pouch-anal anastomosis: is mucosectomy a superior alternative? Surgery 144:533–539

    Article  Google Scholar 

  13. Kmiot WA, Keighley MRB (1989) Totally stapled abdominal restorative proctocolectomy. Br J Surg 76:961–964

    Article  CAS  PubMed  Google Scholar 

  14. Tsunoda A, Talbot IC, Nicholls RJ (1990) Incidence of dysplasia in anorectal mucosa in patients having restorative proctocolectomy. Br J Surg 77:506–508

    Article  CAS  PubMed  Google Scholar 

  15. Schmitt SL, Wexner SD, James K et al (1992) Retained mucosa after double-stapled ileal reservoir and ileoanal anastomosis. Dis Colon Rectum 35:1051–1056

    Article  CAS  PubMed  Google Scholar 

  16. Gilchrist KW, Harms BA, Starling JR (1995) Abdominal rectal mucosa of the anal transitional zone in ulcerative colitis. Arch Surg 130:981–983

    Article  CAS  PubMed  Google Scholar 

  17. Haray PN, Amarmath B, Weiss EG et al (1996) Low malignant potential of the double-stapled ileal pouch-anal anastomosis. Br J Surg 83:1406

    Article  CAS  PubMed  Google Scholar 

  18. Ziv Y, Fazio VW, Sirimarco MT, Lavery IC, Goldblum JR, Petras RE (1994) Incidence, risk factors, and treatment of dysplasia in the anal transitional zone after ileal pouch-anal anastomosis. Dis Colon Rectum 37:1281–1285

    Article  CAS  PubMed  Google Scholar 

  19. Baratsis S, Hadiidimitriou F, Christodolou M et al (2002) Adenocarcinoma in the anal canal sfter ileal pouch- anal anastomosis for ulcerative colitis using a double stapling technique. Dis Colon Rectum 45:687–692

    Article  PubMed  Google Scholar 

  20. Hyman N (2002) Rectal cancer as a complications do stapled IPAA. Inflamm Bowel Dis 8:43–45

    Article  PubMed  Google Scholar 

  21. 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 46:6–13

    Article  PubMed  Google Scholar 

  22. Scarpa M, van Koeten PJ, Ubbink DT et al (2007) Systemic review of dysplasia after restorative proctocolectomy for ulcerative colitis. Br J Surg 94:534–545

    Article  CAS  PubMed  Google Scholar 

  23. Deen KI, Williams JG, Billingham GC et al (1995) Randomized trial to determine the optimum level of pouch-anal anastomosis in stapled restorative proctocolectomy. Dis Colon Rectum 38:133–138

    Article  CAS  PubMed  Google Scholar 

  24. Fazio VW, O’Riordan MG, Lavery IC et al (1999) Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 230:575–586

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Gozzetti G, Poggoili G, Marchetti F et al (1994) Functional outcome in handsewn versus stapled ileal-pouch anastomosis. Am J Surg 168:325–329

    Article  CAS  PubMed  Google Scholar 

  26. Sugarman HJ, Newsome HH (1994) Stapled ileoanal anastomosis without a temporary ileostomy. Am J Surg 167:58–66

    Article  Google Scholar 

  27. McIntyre PB, Pemberton JH, Beart RW et al (1994) Double-stapled vs. handsewn ileal pouch anal anastomosis in patients with chronic ulcerative colitis. Dis Colon Rectum 37:430–433

    Article  CAS  PubMed  Google Scholar 

  28. Schluender SJ, Mei L, Yang H et al (2006) Can a meta-analysis answer the question: is mucosectomy and handsewn or double-stapled anastomosis better in ileal pouch-anal anastomosis. Am Surg 72:912–916

    PubMed  Google Scholar 

  29. Kirat HT, Remzi FH, Kiran RP, Fazio VW (2009) Comparison of outcomes after hand-sewn versus stapled ileal pouch-anal anastomosis in 3109 patients. Surgery 146:723–730

    Article  PubMed  Google Scholar 

Download references

Funding

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

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Authors and Affiliations

  1. Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen’s Hospital, 56 Okazawa cho, Hodogaya ward, Yokohama, 240-8555, Japan

    Akira Sugita, Kazutaka Koganei, Kenji Tatsumi, Ryo Futatsuki, Hirosuke Kuroki & Kyoko Yamada

  2. Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan

    Hideaki Kimura

  3. Matsushima Clinic, Yokohama, Japan

    Tsuneo Fukushima

Authors
  1. Akira Sugita
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  2. Kazutaka Koganei
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  3. Kenji Tatsumi
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  4. Ryo Futatsuki
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  5. Hirosuke Kuroki
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  6. Kyoko Yamada
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  7. Hideaki Kimura
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  8. Tsuneo Fukushima
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Correspondence to Akira Sugita.

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Sugita, A., Koganei, K., Tatsumi, K. et al. Postoperative functional outcomes and complications of partially intraanal canal anastomosis in stapled ileal pouch anal anastomosis for ulcerative colitis. Int J Colorectal Dis 34, 1317–1323 (2019). https://doi.org/10.1007/s00384-019-03322-1

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  • DOI: https://doi.org/10.1007/s00384-019-03322-1

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