Transanal mucosectomy. Ileal pouch advancement for anorectal dysplasia or inflammation after restorative proctocolectomy.
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.
Fazio
V W
VW
Departments of Colorectal Surgery, Cleveland Clinic Foundation, Ohio.
Tjandra
J J
JJ
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*
D000900:Anti-Bacterial Agents