Risk of residual rectal mucosa after proctocolectomy and ileal pouch-anal reconstruction with the double-stapling technique. Postoperative endoscopic follow-up study.
OBJECTIVE
This study was designed to assess the risk of retained rectal mucosa after proctocolectomy and ileal pouch-anal anastomosis with the double-stapling technique.


METHODS
A total of 113 patients underwent proctocolectomy with an ileal pouch-anal reconstruction. In 57 patients the anastomosis between pouch and proximal anal canal was performed using the double-stapling technique. In 26 patients the procedure was carried out without a protecting ileostomy. Of the remaining 31 patients with a proximal ileostomy, 15 underwent endoscopy six weeks postoperatively. Circular biopsies were taken just distal from the pouch-anal anastomosis.


RESULTS
Histologic examination revealed rectal mucosa in at least one biopsy in 7 of 15 patients. At follow-up (mean 18 months) no (distal) pouchitis was clinically noticed. In one patient with familial polyposis, a few polyps, distal of the anastomosis, had to be endoscopically removed.


CONCLUSIONS
Double-stapled ileal pouch-anal anastomosis has a considerable risk of residual rectal mucosa, because of combined linear transection and circular stapling with bilateral dog-ear formation of rectal mucosa. Residual rectal mucosa did not seem to influence clinical results at follow-up.
Slors
J F
JF
Department of Surgery, University of Amsterdam, The Netherlands.
Ponson
A E
AE
Taat
C W
CW
Bosma
A
A
D011125:Adenomatous Polyposis Coli / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000714:Anastomosis, Surgical; D001706:Biopsy; D003093:Colitis, Ulcerative / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D016737:Proctocolectomy, Restorative / Q000009:adverse effects* / Q000379:methods; D012007:Rectum / Q000473:pathology*; D017792:Surgical Stapling / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome