Chronic inflammatory changes in the anal transition zone after stapled ileal pouch-anal anastomosis: is mucosectomy a superior alternative?
BACKGROUND
Chronic inflammation (CI) is commonly found in the anal transition zone (ATZ) after stapled ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). Yet, its impact on defecatory function and the need for a complete mucosectomy has not been completely elucidated. This study aims to evaluate the long-term functional outcomes of patients with CI of the ATZ after stapled IPAA in comparison with mucosectomy patients.


METHODS
Between June 1987 and November 2007, 66 UC patients were found to have CI of the ATZ after stapled IPAA and were compared with 228 UC patients who underwent mucosectomy with hand-sewn (HS) IPAA. Patients were mailed a questionnaire to assess defecatory function and quality of life. Data were analyzed prospectively.


RESULTS
No differences were observed in age, sex, number, or consistency of bowel movements (BMs) between groups. Complete continence was reported by 90.3% of CI and 66.8% of HS patients (P < .001). The CI group also had a significantly lower rate of major incontinence (P < .001). Functional parameters in favor of the CI group included the ability to discriminate between gas and stool (P < .001), the use of protective pads during both the day and the night (P < .001), dietary modifications in the timing of meals (P < .001) and type of food (P = .005), and the presence of perianal rash (P = .019). In the CI group, more patients rated their quality of life as improved from before the operation (P < .001).


CONCLUSIONS
Preservation of the ATZ, even in presence of persistent inflammation, confers improved continence, better functional outcomes, and superior quality of life.
Silvestri
Mark T
MT
Department of Surgery, University of Chicago, Chicago, IL, USA.
Hurst
Roger D
RD
Rubin
Michele A
MA
Michelassi
Fabrizio
F
Fichera
Alessandro
A
D000328:Adult; D017677:Age Distribution; D001003:Anal Canal / Q000473:pathology*; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D002908:Chronic Disease; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D003093:Colitis, Ulcerative / Q000473:pathology / Q000601:surgery*; D039021:Colonic Pouches / Q000473:pathology; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007413:Intestinal Mucosa / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019449:Pouchitis / Q000453:epidemiology / Q000473:pathology*; D011336:Probability; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D017678:Sex Distribution; D017792:Surgical Stapling / Q000009:adverse effects*; D013536:Suture Techniques; D013997:Time Factors