Double-stapled vs. handsewn ileal pouch-anal anastomosis in patients with chronic ulcerative colitis.
Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the treatment of choice for most patients with chronic ulcerative colitis. Whether or not a double-stapled technique, which should preserve the anal transition zone and avoid prolonged and dilation, facilitates superior fecal continence compared with conventional mucosal resection and handsewn anastomosis is unknown.


OBJECTIVE
The aim of this study was to compare functional results after double-stapled and handsewn IPAA.


METHODS
Twenty-seven consecutive patients (13 females, 14 males; mean age, 37 years) who had proctocolectomy and double-stapled IPAA (J) for chronic ulcerative colitis were identified. Each was matched by sex, age, and surgeon to a control who had undergone a conventional handsewn anastomosis. Functional results at six months after ileostomy closure were compared.


RESULTS
Median stool frequency in each group was seven. The prevalence of pouchitis was 22 percent in both groups. One pouch failure occurred in each group. The percentage of patients from the double-stapled group with daytime spotting was similar to that of the handsewn group (18 percent vs. 26 percent, P > 0.5). Nighttime soiling rates were similar as well (41 percent vs. 48 percent, P > 0.5).


CONCLUSIONS
Double-stapled IPAA appears to convey no early functional advantage over handsewn IPAA for chronic ulcerative colitis.
McIntyre
P B
PB
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota 55905.
Pemberton
J H
JH
Beart
R W
RW
Devine
R M
RM
Nivatvongs
S
S
D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical; D003093:Colitis, Ulcerative / Q000503:physiopathology / Q000601:surgery*; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D007410:Intestinal Diseases / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D016737:Proctocolectomy, Restorative / Q000379:methods*; D017792:Surgical Stapling / Q000379:methods*; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome