title: Laparoscopic-assisted ileal pouch-rectal muscle sheath anastomosis for the treatment of familial adenomatous polyposis.
abstract: OBJECTIVE
  Familial adenomatous polyposis (FAP) is a colorectal disease treated by proctocolectomy. While ileal pouch-anal anastomosis preserves the anus, defecation dysfunction and incontinence can occur. We herein report the results of an improved laparoscopic-assisted ileal pouch-rectal muscle sheath anastomosis after total proctocolectomy which preserves anal function, and compare the results with ileal pouch-anal anastomosis.
  
  
  METHODS
  A total of 22 patients with FAP were randomized to receive either ileal pouch-anal anastomosis (n = 11) or ileal pouch-rectal muscle sheath anastomosis (n = 11) after total proctocolectomy. Operation time, intraoperative blood loss, postoperative complications, length of hospitalization and postoperative anal pressure, defecation frequency, and quality of life were recorded and compared between the two groups.
  
  
  RESULTS
  All patients completed a minimum follow-up of 1 year. At the 1 year after the surgery, the daytime defecation frequency was 4.64 ± 0.92 times/day in the ileal pouch-rectal muscle sheath anastomosis group and 6.55 ± 1.13 times/day in the ileal pouch-anal anastomosis group (P = 0.004). Resting anal pressure, maximum squeeze pressure, and average number of daytime defecations in the ileal pouch-rectal muscle sheath group were all better than in the ileal pouch-anal anastomosis group (all, P < 0.05)
  
  
  CONCLUSIONS
  Ileal pouch-rectal muscle sheath anastomosis is associated with better anal function than ileal pouch-anal anastomosis.
authors.affiliation: Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, People's Republic of China. Lianjieliu@hotmail.com
authors.forename: Lian-Jie
authors.initials: LJ
authors.lastname: Liu
authors.forename: Xiao-Hui
authors.initials: XH
authors.lastname: Shi
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Xu
authors.forename: Hai-Feng
authors.initials: HF
authors.lastname: Gong
authors.forename: Chuan-Gang
authors.initials: CG
authors.lastname: Fu
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000503:physiopathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000503:physiopathology; D000714:Anastomosis, Surgical; D039021:Colonic Pouches; D003710:Demography; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000601:surgery*; D011312:Pressure; D011788:Quality of Life; D012007:Rectum / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult