Anal transitional zone and columnar cuff in restorative proctocolectomy.
The popularity of double stapling the ileal pouch-anal anastomosis probably owes more to the technical ease it brings than to histological considerations or functional results. It is preservation of a 'columnar cuff' of mucosa, rather than the restricted site of the anal transitional zone, that should be the focus of research with respect to long-term risk of malignancy and inflammatory complications. If cancer is present in colon that has been removed for ulcerative colitis, there is a 25 per cent incidence of dysplasia in the columnar cuff in the short term. In other circumstances, those who are spared from carcinoma by colectomy are likely to have a similar risk of developing dysplastic change in the columnar cuff with longer follow-up. Double stapling the pouch-anal anastomosis and preserving the anal canal mucosa improves function, but long-term surveillance of the columnar cuff is then required, including biopsies.
Thompson-Fawcett
M W
MW
Department of Colorectal Surgery, John Radcliffe Hospital, Oxford, UK.
Mortensen
N J
NJ
D001003:Anal Canal / Q000473:pathology*; D001004:Anus Diseases / Q000601:surgery*; D001707:Biopsy, Needle; D003093:Colitis, Ulcerative / Q000473:pathology / Q000601:surgery; D006801:Humans; D016737:Proctocolectomy, Restorative / Q000379:methods*; D017792:Surgical Stapling