Surgical treatment and role of dynamic defecography after ileal pouch-anal anastomosis: technical solutions to a difficult problem.
OBJECTIVE
Patients with an ileal pouch-anal anastomosis may develop impaired evacuation of the pouch. A new surgical approach and the role of dynamic defecography in such patients are highlighted.


METHODS
Five patients with ileal pouch-anal anastomosis were assessed clinically and with dynamic defecography before and after reoperation.


RESULTS
In one patient an extensive approach with complete pouch mobilization, stenoplasty of a pouch outlet stenosis, shortening of the rectal remnant, and renewed pouch-anal anastomosis were needed; in three patients, a long and angulated efferent limb was shortened by transabdominal techniques (stenoplasty or a newly developed technique with a linear stapler), and in one patient a pouch inlet stenosis was corrected. In all patients, impaired emptying was cured; in all patients, obstructive abdominal pain improved considerably.


CONCLUSIONS
Dynamic defecography is indispensable for tailoring surgical treatment. Effective transabdominal shortening of the efferent limb can be performed with the aid of a linear stapler.
Silvis
R
R
Department of Surgery, University Hospital Utrecht, The Netherlands.
Delemarre
J B
JB
Gooszen
H G
HG
D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical; D003672:Defecation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative; D011859:Radiography; D012002:Rectal Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D012007:Rectum / Q000000981:diagnostic imaging*; D012086:Reoperation