Anal canal pressure after ileal pouch-anal anastomosis with strengthened internal anal sphincter.
BACKGROUND
The aim of sphincter-saving operative techniques and creation of intestinal reservoirs is to improve the quality of life for patients with restorative prococolectomy.


METHODS
In this study, 48 consecutive patients (19 males and 29 females of ages between 19 and 55 years; mean age, 35.52 years) with ulcerative colitis and familial adenomatous polyposis underwent ileal pouch-anal anastomosis after proctocolectomy in 1986 to 2002. In 26 patients (54.17 percent of the cases), 10 males and 16 females, ileal pouch-anal anastomosis was performed after a modified surgical technique for strengthening the internal anal sphincter by creation of a smooth muscle cuff through plication of a mucosectomized segment of residual rectum. Basal resting anal canal pressure and pressure after voluntary contraction were recorded preoperatively, one month after surgery, and every six months for two years.


RESULTS
One month after the operation manometric results showed significantly higher values of resting pressure in patient with a plicated rectal segment than values measured preoperatively (P < 0.001). This effect was absent after the standard ileal pouch-anal anastomosis. With the rectal plication technique, basal pressure increased from a preoperative value of 69 +/- 6 mmHg up to 80 +/- 6 mmHg at the end of the second postoperative year (P < 0.001).


CONCLUSIONS
We concluded that ileal pouch-anal anastomosis with rectal plication perhaps improved sphincter function. The operative technique did not affect anal squeeze pressure. Patients quality of life was improved for those undergoing the modified ileal pouch-anal anastomosis.
Kobakov
Georgi L
GL
Clinic of General and Operative Surgery, St. Marina University Hospital of Varna, Varna, Bulgaria. glkobakov@yahoo.co.uk
Kostov
Daniel V
DV
Temelkov
Temelko D
TD
D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000328:Adult; D001003:Anal Canal / Q000502:physiology* / Q000601:surgery*; D000714:Anastomosis, Surgical; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011312:Pressure; D016737:Proctocolectomy, Restorative; D011788:Quality of Life; D012007:Rectum / Q000601:surgery*; D016896:Treatment Outcome