title: The ileo neo rectal anastomosis: long-term results of surgical innovation in patients after ulcerative colitis and familial adenomatous polyposis.
abstract: OBJECTIVE
  Restorative proctocolectomy with ileo neo rectal anastomosis (INRA) combines cure of ulcerative colitis (UC) or familial adenomatous polyposis (FAP) with restoration of intestinal continuity. Evaluation of long-term results was needed to determine if there is a place for INRA in the armamentarium of a surgeon besides the ileal pouch anal anastomosis (IPAA).
  
  
  METHODS
  All patients with INRA were included in the analysis. Patient demographics and clinical and follow-up data (morbidity, dietary problems, defecation frequency, fecal continence, anal and neorectal physiology, and neorectal mucosa assessment) were registered prospectively.
  
  
  RESULTS
  Seventy-nine patients were enrolled, and in 58 patients (50 UC, 8 FAP), INRA was successful. In 21 patients, intraoperative conversion to IPAA was needed. In 49 patients with INRA, a functional reservoir was achieved. No pelvic sepsis or bladder or sexual dysfunction occurred. Thirteen patients experienced episodes of reservoir inflammation. Median bowel movements of six (5, 8) with a nocturnal defecation frequency of one were recorded with fecal continence or minor incontinence. Anal manometry and neorectal physiology showed a decrease in resting pressure and an increase in squeeze pressure and maximum tolerated volume. The median follow-up was 8.1 years (6.7, 10.1).
  
  
  CONCLUSIONS
  This is an example of a surgical innovation with a theoretical potential to be superior to the current technique. This potential was not confirmed in short- and long-term evaluations. Hence, IPAA is currently the best available alternative to a conventional ileostomy.
authors.affiliation: Department of Surgery, Radboud University Nijmegen Medical Centre, Route 690, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands. j.heikens@chir.umcn.nl
authors.forename: Joost T
authors.initials: JT
authors.lastname: Heikens
authors.forename: Hein G
authors.initials: HG
authors.lastname: Gooszen
authors.forename: Johannes L J M
authors.initials: JL
authors.lastname: Teepen
authors.forename: Willem E
authors.initials: WE
authors.lastname: Hueting
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Oostvogel
authors.forename: Theo J M V
authors.initials: TJ
authors.lastname: van Vroonhoven
authors.forename: J Han J M
authors.initials: JH
authors.lastname: van Krieken
authors.forename: Cees J H M
authors.initials: CJ
authors.lastname: van Laarhoven
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000328:Adult; D000714:Anastomosis, Surgical; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D016737:Proctocolectomy, Restorative / Q000379:methods*; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D016896:Treatment Outcome