title: Ileal pouch-anal anastomosis: is preoperative anal manometry predictive of postoperative functional outcome?
abstract: OBJECTIVE
  The aim of this study was to determine the value of preoperative anal manometry in predicting post-operative continence.
  
  
  METHODS
  Anal manometry was performed in 73 consecutive patients before ileal pouch-anal anastomosis (IPAA) surgery (m1), before loop ileostomy closure (m2), and at a follow-up of one (m3) and two (m4) years. Mean and maximum resting and squeezing pressures were documented at each occasion. One year after surgery, pressures were correlated (r) with an incontinence score.
  
  
  RESULTS
  A significant (P < 0.05) decrease in mean resting pressures was observed after IPAA (m1 = 66 mmHg; m2 = 42.8 mmHg), followed by a significant (P < 0.05) improvement of mean resting pressure after loop ileostomy closure (m3 = 53.8 mmHg; m4 = 54.7 mmHg). Mean squeezing pressures did not change (P > 0.05) at any time during the study (m1 = 114 mmHg; m2 = 102.9 mmHg; m3 = 103.4 mmHg; m4 = 95.8 mmHg). There was no correlation between preoperative mean resting pressure and postoperative (mI) incontinence score.
  
  
  CONCLUSIONS
  Anal manometry showed a characteristic trend in internal anal sphincter injury after IPAA followed by recovery after ileostomy closure. However, it failed to prove helpful in the prediction of clinical outcome. Thus, although this study supports the continued use of manometry in a research setting, it challenges the value of routine manometry in a clinical context.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309.
authors.forename: P J
authors.initials: PJ
authors.lastname: Morgado
authors.forename: S D
authors.initials: SD
authors.lastname: Wexner
authors.forename: K
authors.initials: K
authors.lastname: James
authors.forename: J J
authors.initials: JJ
authors.lastname: Nogueras
authors.forename: D G
authors.initials: DG
authors.lastname: Jagelman
mesh_terms: D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery*; D000714:Anastomosis, Surgical; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D007082:Ileum / Q000503:physiopathology / Q000601:surgery*; D008365:Manometry; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011312:Pressure; D016737:Proctocolectomy, Restorative; D016896:Treatment Outcome