title: "Small is beautiful" A series of ileo-anal anastomoses performed with the 25 - mm circular stapler.
abstract: OBJECTIVE
  With the idea that a small diameter stapler should cause less sphincter trauma, we began to use the 25mm circular stapler to perform ileo-pouch-anal anastomosis (IPAA) and we report our experience.
  
  
  METHODS
  A retrospective study using a bowel function questionnaire and a quality of life questionnaire has been conducted on a group of patients who underwent IPAA using a 25mm stapler
  
  
  RESULTS
  We performed IPAA using a 25mm circular stapler in 37 patients. Postoperative mortality was nil and morbidity was 27%. One anastomotic stenosis occurred. Long term follow-up information was available on 28 patients. Mean follow-up was 70 months (range 8-177). Mean number of bowel movements was 4.5 (range 2-10, median 4.5) during the day and 0.9 (range 0-10, median 0) at night. Out of 28 patients, 19 (68%) were fully continent and 32% had occasional soiling, no one reported incontinence. All patients except one were able to withold their stool for more than 15 minutes. Daytime pad use was: never 86%, occasionally 3%, frequently 11%; nightime pas use was never 86%, occasionally 7% and frequently 7%. Bowel regulating drugs use was never 82%, occasionally 14%, regularly 4%. Evacuation difficulties were: never 75%, occasionally 21%, frequently 4%.
  
  
  CONCLUSIONS
  Our results compare favourably with the literature, which reports median bowel frequency 6-7.6/24h, 9.4- 33% urgency, 17-44% daytime soiling and 32-61% nighttime soiling.
  
  
  CONCLUSIONS
  Our results must be considered preliminary but we found the 25-mm stapler safe and adequate to perform IPAA.
  
  
  BACKGROUND
  IPAA, Ulcerative Colitis, Stapler, Function.
authors.forename: Andrea
authors.initials: A
authors.lastname: Resegotti
authors.forename: Stefano
authors.initials: S
authors.lastname: Silvestri
authors.forename: Marco
authors.initials: M
authors.lastname: Astegiano
authors.forename: Giacomo
authors.initials: G
authors.lastname: Deiro
authors.forename: Davide
authors.initials: D
authors.lastname: Ribaldone
authors.forename: Davide
authors.initials: D
authors.lastname: Cassine
authors.forename: Alessandro
authors.initials: A
authors.lastname: Franchello
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D013505:Digestive System Surgical Procedures / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000295:instrumentation* / Q000379:methods*; D011788:Quality of Life; D012189:Retrospective Studies; D057566:Self Report; D013528:Surgical Staplers; D055815:Young Adult