title: Manometric and functional comparison of ileal pouch anal anastomosis with and without anal manipulation.
abstract: We report the results of postoperative physiologic and functional evaluation of 153 patients with ileal pouch anal-anastomosis (IPAA). Ninety-nine patients had anal manipulation for either mucosal proctectomy, transanal placement pursestring suture with stapled IPAA, or handsewn IPAA (manipulation). Fifty-four patients had stapled IPAA with anal pursestrings placed transabdominally without mucosectomy (no manipulation). Patients with transabdominal anal pursestring placement and stapled IPAA without mucosectomy had a higher mean maximum anal resting pressure than patients who had endoanal manipulation. This correlates with improved continence and a reduced need to wear a pad. Avoidance of anal manipulation preserves anal canal resting tone and improves the functional result after IPAA.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Foundation, Ohio 44195-5044.
authors.forename: W
authors.initials: W
authors.lastname: Tuckson
authors.forename: I
authors.initials: I
authors.lastname: Lavery
authors.forename: V
authors.initials: V
authors.lastname: Fazio
authors.forename: J
authors.initials: J
authors.lastname: Oakley
authors.forename: J
authors.initials: J
authors.lastname: Church
authors.forename: J
authors.initials: J
authors.lastname: Milsom
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D003672:Defecation; D005260:Female; D006801:Humans; D007081:Ileostomy; D007082:Ileum / Q000601:surgery*; D008297:Male; D008365:Manometry