Anoneorectal evaluation after colectomy and endorectal ileoanal anastomosis in children and young adults.
Recent improvements in the technique of colectomy, rectal mucosectomy, and endorectal ileoanal anastomosis allow a satisfactory result in most patients. However, the clinical outcome is not entirely satisfactory in about 5% to 10% of patients because of excessive stool frequency or episodic fecal incontinence or both. We evaluated anoneorectal function postoperatively to help explain the mechanisms of the difficulties. Six patients with imperfect functional results (group 1) and 6 with good functional results (group 2) after ileoanal anastomosis and closure of the loop ileostomy were compared with 12 healthy volunteers who had not had operation, through a series of tests designed to evaluate anal sphincter and neorectal function. All patients were instructed in balloon dilation of the neorectum to develop a reservoir while awaiting closure of the ileostomy. Anal sphincter manometric measurements of resting and squeeze pressures were obtained with a 4-channel probe attached to a noncompliant pneumohydraulic perfusion system. Incremental inflation of an intraluminal bag while pressures were simultaneously recorded allowed determinations of neorectal capacity and distensibility. The efficiency of neorectal evacuation was assessed by instilling a labeled synthetic viscous load into the distal bowel. Patients in group 1 had lower resting anal pressures (P less than 0.05), lower squeeze pressures (P less than 0.05), smaller neorectal capacities (P = 0.13), and less neorectal distensibility (P = 0.27) than patients in group 2. Furthermore, the values for patients in group 2 closely approximated those found in healthy volunteers.(ABSTRACT TRUNCATED AT 250 WORDS)
D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000601:surgery; D003111:Colonic Polyps / Q000601:surgery; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D011312:Pressure; D012007:Rectum / Q000503:physiopathology* / Q000601:surgery*