Ano-neorectal function using manometry on patients with soiling at 10 years or more after ilheal J pouch-anal anatomosis for ulceraitive colitis.
OBJECTIVE
Physiological assessments of the ano-neorectum in patients with soiling at long-term period after total colectomy, mucosal protectomy, and ileal J pouch-anal anastomosis with short rectal cuff (IPAA) are still inconclusive. The purpose of this study was to clarify the pathophysiology of ano-neorectal functions in patients with or without soiling at 10 years or more after IPAA for ulcerative colitis (UC).


METHODS
Twenty-five patients after IPAA for UC were mamometrically studied. There were 17 men and 8 women, aged 38-58 years (mean 48.3 years). Patients after IPAA were divided into 2 groups [15 patients without soiling (10 men and 5 women, aged 38 to 52 years with a mean age of 47.9 years), 10 patients with soiling (7 men and 3 women, aged 42 to 58 years with a mean age of 49.3 years)]. The median follow-up time from closure of the diverting ileostomy was 126.9 months (range 120-136). No patients experienced any major complaints in the postoperative course.


RESULTS
Ten patients (40.0%) did experience an occasional soiling (a small amount of soiling in day time; 1 to 2 times per week, nocturnal soiling;1 time per 1 to 2 nights). Patients with soiling showed the worst results in the ano-neorectal manometry (anal sphincter dysfunction; lower resting and squeeze pressure, neorectal sensory dysfunction; increase of sensory threshold volume) compared with patients without soiling. Neorectal capacity function (maximamum neorectal tolerated threshold volume and neorectal compliance) and ano-neorectal inhibitory reflex showed no difference between patients without soiling and patients with soiling. These results are probably due to the injury to the internal anal sphincter, external anal sphincter, and rectal cuff caused during the operation.


CONCLUSIONS
Patients with soiling at 10 years or more after IPAA showed anal sphincter dysfunction and neorectal sensory dysfunction. The IPAA should not cause damage to the ano-rectal apparatus during rectal mobilization, making short rectal cuff, and mucosectomy.
Tomita
Ryouichi
R
Department of Surgery, Nippon Dental University, School of Dentistry at Tokyo, Nihon University School of Medicine, Japan. rtomita-ndus@mvg.biglobe.ne.jp
D000328:Adult; D001003:Anal Canal / Q000503:physiopathology* / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D003093:Colitis, Ulcerative / Q000601:surgery; D039021:Colonic Pouches / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology*; D011312:Pressure; D012018:Reflex