title: Transanal mucosectomy. Ileal pouch advancement for anorectal dysplasia or inflammation after restorative proctocolectomy.
abstract: OBJECTIVE
  Restorative proctocolectomy has gained increasing popularity in the surgical treatment of ulcerative colitis. However, symptomatic proctitis in an excessively long anorectal stump or high-grade dysplasia within the retained anorectal mucosa can pose challenging problems. A corrective operation for these problems is described.
  
  
  METHODS
  A sphincter-preserving perineal approach to mobilize the pouch was described. It allows excision of the inflamed or dysplastic-retained anorectal mucosa, followed by pouch advancement and a neoileoanal anastomosis.
  
  
  RESULTS
  The technique was successfully performed in two patients, one with symptomatic "proctitis" and another with high-grade dysplasia in the anorectal mucosa after a previously stapled ileoanal (distal rectal) anastomosis.
  
  
  CONCLUSIONS
  This report illustrates the relative ease and safety of delayed mucosectomy via a perineal approach, provided that the initially stapled anastomosis is within 3 cm to 4 cm of the dentate line. This technique also obviates the need for complex abdominopelvic surgery after previous restorative proctocolectomy.
authors.affiliation: Departments of Colorectal Surgery, Cleveland Clinic Foundation, Ohio.
authors.forename: V W
authors.initials: VW
authors.lastname: Fazio
authors.forename: J J
authors.initials: JJ
authors.lastname: Tjandra
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000150:complications / Q000601:surgery*; D003131:Combined Modality Therapy; D003672:Defecation; D005242:Fecal Incontinence / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007081:Ileostomy; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011349:Proctitis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012086:Reoperation; D012811:Sigmoid Neoplasms / Q000150:complications / Q000601:surgery*
chemical_list: D000900:Anti-Bacterial Agents