State of the defunctionalized sphincter in patients undergoing ileoanal pouch anastomosis.
OBJECTIVE
Our aim was to determine manometric status and functional outcome of the ileoanal pouch procedure in a subset of patients with defunctionalized anal sphincters as a result of long-term fecal diversion.


METHODS
The anal manometric profiles of 12 patients defunctionalized for one year or more were compared with 26 patients with nondefunctionalized anal sphincters. Functional data were obtained from the Lahey Clinic Ileoanal Pouch Registry.


RESULTS
Preoperative manometric data revealed a mean resting pressure of 91.5 mmHg in the nondefunctionalized group vs. 68.7 mmHg in the defunctionalized group; mean squeezing pressure was 171.7 mmHg (nondefunctionalized group) vs. 102.3 mmHg (defunctionalized group); and squeezing pressure volume was 1,283,000 mmHg3 (nondefunctionalized group) vs. 585,000 mmHg3 (defunctionalized group). Functionally both groups had a mean of 6.1 bowel movements in a 24-hour period and could defer defecation for a mean of 2 hours. Leakage occurred in 22 percent of the defunctionalized group and 17 percent of the nondefunctionalized group (P = 0.35).


CONCLUSIONS
Despite physiologic perturbations, the long-term, defunctionalized anal sphincter can adequately support a restorative procedure without regard to timing of pouch creation.
Staniunas
R J
RJ
Department of Colon and Rectal Surgery, Lahey Clinic, Burlington, Massachusetts 01805, USA.
Keck
J O
JO
Counihan
T
T
Marcello
P
P
Barrett
R C
RC
Oster
M
M
Roberts
P L
PL
Schoetz
D J
DJ
Murray
J J
JJ
Veidenheimer
M C
MC
D011125:Adenomatous Polyposis Coli / Q000601:surgery; D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000473:pathology / Q000503:physiopathology*; D000714:Anastomosis, Surgical; D003093:Colitis, Ulcerative / Q000601:surgery; D003672:Defecation; D005242:Fecal Incontinence / Q000503:physiopathology; D005243:Feces; D005260:Female; D005414:Flatulence / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009119:Muscle Contraction; D011312:Pressure; D016737:Proctocolectomy, Restorative; D012189:Retrospective Studies