title: Ileal pouch anal anastomosis with close rectal dissection using automated vessel sealers for ulcerative colitis: a promising alternative.
abstract: BACKGROUND
  Despite decennia of experience, ileal pouch anal anastomosis for ulcerative colitis is still associated with high complication rates. The development of automatic vessel sealers has resulted in the revival of a promising surgical alternative to the conventional procedure: close rectal dissection. By preserving the mesorectal layer it is hypothesized that nerve-related and other postoperative complications can be reduced.
  
  
  METHODS
  All patients with ulcerative colitis with indication for restorative proctocolectomy at our institution during the pilot study underwent the close rectal pouch procedure with temporary diverting ileostomy. Standardized clinical history, anorectal physiology measurements, and endoscopic and histological examination were carried out before and after surgery.
  
  
  RESULTS
  The procedure was technically successful in all 10 patients, with a median age of 41 years and a median postoperative follow-up period of 16 months. There were no cases of pelvic sepsis and bladder or sexual dysfunction. The median daytime defecation frequency was 6.0. Endoscopic and histological examination showed no abnormalities. The anorectal physiology supported the good functional results.
  
  
  CONCLUSIONS
  The preliminary results of the close rectal pouch procedure are promising, with good functional results and a low complication rate after 1 year.
authors: Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. s.dezeeuw@chir.umcn.nl
authors: Sharonne
authors: S
authors: de Zeeuw
authors: Usama
authors: U
authors: Ahmed Ali
authors: Marion B M
authors: MB
authors: van der Kolk
authors: Kees C J H M
authors: KC
authors: van Laarhoven
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000503:physiopathology; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects; D003672:Defecation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010865:Pilot Projects; D016737:Proctocolectomy, Restorative / Q000009:adverse effects* / Q000379:methods*; D012007:Rectum / Q000601:surgery*; D018805:Sepsis / Q000209:etiology; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D014555:Urination Disorders / Q000209:etiology; D055815:Young Adult