title: Ileal pouch anal anastomosis with modified double-stapled mucosectomy--the experience in China.
abstract: OBJECTIVE
  To investigate the feasibility and long-term functional outcome of ileal pouch-anal anastomosis with modified double-stapled mucosectomy.
  
  
  METHODS
  From January 2002 to March 2011, fourty-five patients underwent ileal pouch anal anastomosis with modified double-stapled mucosectomy technique and the clinical data obtained for these patients were reviewed.
  
  
  RESULTS
  Patients with ulcerative colitis (n = 29) and familial adenomatous polyposis (n = 16) underwent ileal pouch-anal anastomosis with modified double-stapled mucosectomy. Twenty-eight patients underwent one-stage restorative proctocolectomy, ileal pouch anal anastomosis, protective ileostomy and the ileostomy was closed 4-12 mo postoperatively. Two-stage procedures were performed in seventeen urgent patients, proctectomy and ileal pouch anal anastomosis were completed after previous colectomy with ileostomy. Morbidity within the first 30 d of surgery occurred in 10 (22.2%) patients, all of them could be treated conservatively. During the median follow-up of 65 mo, mild to moderate anastomotic narrowing was occurred in 4 patients, one patient developed persistent anastomotic stricture and need surgical intervention. Thirty-five percent of patients developed at least 1 episode of pouchitis. There was no incontinence in our patients, the median functional Oresland score was 6, 3 and 2 after 1 year, 2.5 years and 5 years respectively. Nearly half patients (44.4%) reported "moderate functioning", 37.7% reported "good functioning", whereas in 17.7% of patients "poor functioning" was observed after 1 year. Five years later, 79.2% of patients with good function, 16.7% with moderate function, only 4.2% of patients with poor function.
  
  
  CONCLUSIONS
  The results of ileal pouch anal anastomosis with modified double-stapled mucosectomy technique are promising, with a low complication rate and good long-term functional results.
authors.affiliation: Department of General Surgery, RuiJin Hospital Affiliated Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
authors.forename: Ya-Jie
authors.initials: YJ
authors.lastname: Zhang
authors.forename: Yi
authors.initials: Y
authors.lastname: Han
authors.forename: Mou-Bin
authors.initials: MB
authors.lastname: Lin
authors.forename: Yong-Gang
authors.initials: YG
authors.lastname: He
authors.forename: Hao-Bo
authors.initials: HB
authors.lastname: Zhang
authors.forename: Lu
authors.initials: L
authors.lastname: Yin
authors.forename: Liang
authors.initials: L
authors.lastname: Huang
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D002681:China; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects; D007082:Ileum / Q000601:surgery*; D007413:Intestinal Mucosa / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D016737:Proctocolectomy, Restorative; D012086:Reoperation; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Familial adenomatous polyposis; Ileal pouch anal anastomosis; Stapled mucosectomy; Surgical technique; Ulcerative colitis