Differences in ano-neorectal physiology of ileoanal and coloanal reconstructions for restorative proctectomy

Objective  Restorative proctectomy with straight coloanal anastomosis (CAA) and restorative proctocolectomy with ilealpouch‐anal anastomosis (IPAA) are options for maintaining bowel integrity after rectal resection. The aim of this study was to compare clinical function and anorectal physiology in p...

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Bibliographic Details
Published in:Colorectal disease 2010-04, Vol.12 (4), p.342-350
Main Authors: Rink, A. D., Kneist, W., Radinski, I., Guinot-Barona, A., Lang, H., Vestweber, K.-H.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Anal Canal - physiology
Colitis, Ulcerative - surgery
continence
Defecation - physiology
Fecal Incontinence - etiology
Follow-Up Studies
Humans
Male
Manometry
Middle Aged
pouch
Proctocolectomy, Restorative - adverse effects
Proctocolectomy, Restorative - methods
Recovery of Function
Rectal cancer
Rectum - physiology
ulcerative colitis
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Summary:Objective  Restorative proctectomy with straight coloanal anastomosis (CAA) and restorative proctocolectomy with ilealpouch‐anal anastomosis (IPAA) are options for maintaining bowel integrity after rectal resection. The aim of this study was to compare clinical function and anorectal physiology in patients treated with CAA and IPAA. Method  Three‐dimensional vector‐manometry and neorectal volumetry were performed in straight CAA [53 patients (34 male)] and IPAA [61 patients (39 male)] for ulcerative colitis. Function was assessed using a 14 day incontinence diary. Results  Function was similar in both groups, but neorectal compliance and threshold volumes for sensation, urge and maximum tolerated volume (MTV) were significantly higher after IPAA than after CAA. Mean pressure, vector volume and sphincter symmetry at rest were significant determinants of continence in both groups but squeeze pressure did not correlate significantly with function in either group. Threshold volume, MTV, and compliance were significantly correlated with frequency of defecation in patients with IPAA but not with CAA. Conclusion  A strong consistent resting anal sphincter pressure is one determinant of continence after both IPAA and CAA. Squeeze pressures do not influence the functional result. In IPAA but not CAA, the neorectum has a reservoir function which correlates with the postoperative frequency of defaecation.
ISSN:1462-8910
1463-1318
DOI:10.1111/j.1463-1318.2009.01790.x