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KMID : 0356720010170060295
Journal of the Korean Society of Coloproctology
2001 Volume.17 No. 6 p.295 ~ p.303
Is the Level of Anastomosis within the Anal Canal Pertinent to Physiologic and Functional Outcome in the Double-stapled Ileoanal Reservoir?
Choi Hong-Jo

Choi Jung-Seok
Naoto Saigusa
Shin Eung-Jin
Eric G. Weiss
Juan J. Noguersa
Steven D. Wexner
Abstract
Purpose: The aims of this investigation were to access the relative ratio of epithelial types within the anal canal after a double-stapled ileoanal reservoir (DSIAR) and to review physiologic and functional differences based on this
diversity in epithelial types.

Methods: According to types of the epithelium present at histologic sections of the distally excised tissue ring ("donut") after the stapling for restorative proctocolectomy with construction of a DSIAR, one hundred thirty-eight patients with ulcerative colitis were stratified into two groups: 40 patients (22 males and 18 females) were categorized to be of lower anastomosis (group ¥°), where squamous, squamous mixed with columnar, or squamocuboidal component was reported to be present, and 98 patients (50 males and 48 females) to be of higher one (group ¥±), which was evidenced by columnar epithelium at the "donut". Physiologic and functional parameters were appraised between 2 groups to define whether this difference in epithelial types is associated with a significant difference in postoperative anorectal functional outcome.

Results: None of preoperative parameters reflecting resting and squeeze pressures showed significant differences between 2 groups. Postoperative mean and maximal resting pressures (MRP and MxRP) were declined to 48.8¡¾16.9 §®Hg and 67.1¡¾21.3 §®Hg in group ¥°, and 61.1¡¾22.7 §®Hg and 90.0¡¾38.6 §®Hg in group ¥±, differences of which were significant (P=0.046 and 0.031, respectively). Neither postoperative mean nor maximal squeeze pressure was, however, statistically different between 2 groups. Mean length of the high pressure zone was decreased in both groups postoperatively, but there were no intergroup differences. Rectoanal inhibitory reflex decreased significantly from 97.4% to 50% in group ¥° and from 86.5% to 53.9% in group ¥±, respectively (P<0.0001 in both). However, there was no significant intergroup difference postoperatively. Maximal tolerance volume and compliance of the reservoir were significantly improved postoperatively in both groups; from 52.2¡¾26.1 §¢ and 2.8¡¾3.3 to 163.3¡¾115.7 §¢ and 14.7¡¾15.3 in group ¥°(P=0.0001, and <0.0001, respectively), and from 77.0¡¾59.5 §¢ and 4.4¡¾6.8 to 167.3¡¾87.9 §¢ and 28.7¡¾44.0 in group ¥± (P<0.0001, both). But there was no intergroup difference in either parameters postoperatively. There were no significant differences between groups relative to functional outcome except the diurnal incontinence to solid stool (P<0.011).

Conclusions: Although epithelial types were shown to be variable at the anal side of the anastomosis after a DSIAR, these differences were not associated with physiologic and functional differences. Therefore, if technically feasible, this procedure can be performed with safety without fear of significant functional derangement.
KEYWORD
Double-stapled ileoanal reservoir, Anal transitional zone, Anorecatal manometry, Functional outcome
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