Functional results and visceral perception after ileo neo-rectal anastomosis in patients: a pilot study.
BACKGROUND
To reduce pouch related complications after restorative proctocolectomy, an alternative procedure was developed, the ileo neo-rectal anastomosis (INRA). This technique consists of rectal mucosa replacement by ileal mucosa and straight ileorectal anastomosis. Our study provides a detailed description of the functional results after INRA.


METHODS
Eleven patients underwent an INRA procedure with a temporary ileostomy. Anorectal function tests were performed two months prior to and six and 12 months after closure of the ileostomy and comprised: anal manometry, ultrasound examination, rectal balloon distension, and transmucosal electrical nerve stimulation (TENS). Function was subsequently related to the histopathology of rectal biopsy samples.


RESULTS
Median stool frequency decreased from 15/24 hours (10-25) to 6/24 hours (4-11) at one year. All patients reported full continence. Anal sensibility, and resting and squeeze pressures did not change after INRA. Rectal compliance decreased (2.1 (0.7-2.8) v 1.5 (0.4-2.2) and 1.4 (0.8-3.7) ml/mm Hg (p=0.03)) but the maximum tolerated volume increased (70 (50-118) v 96 (39-176) (NS) and 122 (56-185) ml (p=0.03)). Decreasing rectal sensitivity was found: the maximum tolerated pressure increased (14 (8-24) v 22 (8-34) (NS) and 26 (14-40) (p=0.02)) and the rectal threshold for TENS displayed a similar tendency. All patients displayed a low grade chronic inflammatory infiltrate in neorectal biopsy samples before closure of the ileostomy, with no change during follow up.


CONCLUSIONS
The technique of INRA provides a safe alternative for restorative surgery. Stool frequency after INRA improves with time and seems to be related to decreasing sensitivity and not to histopathological changes in the neorectum. Furthermore, after the INRA procedure, all patients reported full continence.
Andriesse
G I
GI
Department of Surgery, University Medical Centre Utrecht, the Netherlands. g.i.andriesse@lab.azu.nl
Gooszen
H G
HG
Schipper
M E
ME
Akkermans
L M
LM
van Vroonhoven
T J
TJ
van Laarhoven
C J
CJ
D011125:Adenomatous Polyposis Coli / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D002404:Catheterization; D003093:Colitis, Ulcerative / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005769:Gastrointestinal Motility / Q000502:physiology; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications / Q000209:etiology; D019449:Pouchitis / Q000209:etiology; D016737:Proctocolectomy, Restorative / Q000379:methods*; D018709:Statistics, Nonparametric; D004561:Transcutaneous Electric Nerve Stimulation; D016896:Treatment Outcome; D014463:Ultrasonography