Proctocolectomy and Ileal Pouch-Anal Anastomosis: The Double-Stapled Technique

ABSTRACT

Restorative proctocolectomy with ileal pouch-anal anastomosis is currently the preferred surgical treatment for most patients suffering from ulcerative colitis or familial adenomatous polyposis coli. The double-stapled technique of transection of the proximal anal canal and anastomosis has proven to be technically easier and to provide better functional outcomes than mucosectomy and hand-sewn pouch-anal anastomosis at the dentate line. Concerns regarding the development of rectal carcinoma or dysplasia in the cuff of retained rectal mucosa have not been realized.

Restorative proctocolectomy - ileal pouch-anal anastomosis - mucosectomy - double-stapled anastomosis - ileoanal pouch

REFERENCES

• 1 Parks A G, Nicholls R J, Belliveau P. Proctocolectomy with ileal reservoir and anal anastomosis.  Br J Surg . 1980;  67 533-538
• 2 Meagher A P, Farouk R, Dozois R R, Kelly K A, Pemberton J H. J ileal pouch-anal anastomosis for chronic ulcerative colitis: complications and long-term outcome in 1310 patients.  Br J Surg . 1998;  85 800-803
• 3 Fazio V W, Ziv Y, Church J M. et al . Ileal pouch-anal anastomoses complications and function in 1005 patients.  Ann Surg . 1995;  222 120-127
• 4 Lavery I C, Tuckson W B, Easley K A. Internal anal sphincter function after total abdominal colectomy and stapled ileal pouch-anal anastomosis without mucosal proctectomy.  Dis Colon Rectum . 1989;  32 950-953
• 5 Tuckson W B, McNamara M J, Fazio V W, Lavery I C, Oakley J R. Impact of anal manipulation and pouch design on ileal pouch function.  J Natl Med Assoc . 1991;  83 1089-1092
• 6 Heald R J, Allen D R. Stapled ileo-anal anastomosis: a technique to avoid mucosal proctectomy in the ileal pouch operation.  Br J Surg . 1986;  73 571-572
• 7 Deen K I, Williams J G, Grant E A, Billingham C, Keighley M R. Randomized trial to determine the optimum level of pouch-anal anastomosis in stapled restorative proctocolectomy.  Dis Colon Rectum . 1995;  38 133-138
• 8 Becker J M, LaMorte W, St Marie G, Ferzoco S. Extent of smooth muscle resection during mucosectomy and ileal pouch-anal anastomosis affects anorectal physiology and functional outcome.  Dis Colon Rectum . 1997;  40 653-660
• 9 Saigusa N, Choi H J, Wexner S D. et al . Double stapled ileal pouch-anal anastomosis (DS-IPAA) for mucosal ulcerative colitis (MUC): is there a correlation between the tissue type in the circular stapler donuts and in follow-up biopsy?.  Colorectal Dis . 2003;  5 153-158
• 10 Khubchandani I T, Kontostolis S B. Outcome of ileorectal anastomosis in an inflammatory bowel disease surgery experience of three decades.  Arch Surg . 1994;  129 866-869
• 11 Pastore R L, Wolff B G, Hodge D. Total abdominal colectomy and ileorectal anastomosis for inflammatory bowel disease.  Dis Colon Rectum . 1997;  40 1455-1464
• 12 Vasen H F, van Duijvendijk P, Buskens E. et al . Decision analysis in the surgical treatment of patients with familial adenomatous polyposis: a Dutch-Scandinavian collaborative study including 659 patients.  Gut . 2001;  49 231-235
• 13 Lavery I C, Sirimarco M T, Ziv Y, Fazio V W. Anal canal inflammation after ileal pouch-anal anastomosis. The need for treatment.  Dis Colon Rectum . 1995;  38 803-806
• 14 Thompson-Fawcett M W, Mortensen N J, Warren B F. “Cuffitis” and inflammatory changes in the columnar cuff, anal transitional zone, and ileal reservoir after stapled pouch-anal anastomosis.  Dis Colon Rectum . 1999;  42 348-355
• 15 Tsunoda A, Talbot I C, Nicholls R J. Incidence of dysplasia in the anorectal mucosa in patients having restorative proctocolectomy.  Br J Surg . 1990;  77 506-508
• 16 Ziv Y, Fazio V W, Sirimarco M T, Lavery I C, Goldblum J R, Petras R E. Incidence, risk factors, and treatment of dysplasia in the anal transitional zone after ileal pouch-anal anastomosis.  Dis Colon Rectum . 1994;  37 1281-1285
• 17 Puthu D, Rajan N, Rao R, Rao L, Venugopal P. Carcinoma of the rectal pouch following restorative proctocolectomy. Report of a case.  Dis Colon Rectum . 1992;  35 257-260
• 18 Rodriguez S J, Polavieja M G, Naranjo A, Castillo J. Adenocarcinoma in an ileal pouch for ulcerative colitis Dis Colon Rectum .  1995;  38 779-780
• 19 Stern H, Walfisch S, Mullen B, McLeod R, Cohen Z. Cancer in an ileoanal reservoir: a new late complication?.  Gut . 1990;  31 473-475
• 20 Brown S R, Donati D, Seow-Choen F. Rectal cancer after mucosectomy for ileoanal pouch in familial adenomatous polyposis: report of a case.  Dis Colon Rectum . 2001;  44 1714-1715
• 21 von Herbay A, Stern J, Herfarth C. Pouch-anal cancer after restorative proctocolectomy for familial adenomatous polyposis.  Am J Surg Pathol . 1996;  20 995-999
• 22 Hoehner J C, Metcalf A M. Development of invasive adenocarcinoma following colectomy with ileoanal anastomosis for familial polyposis coli. Report of a case.  Dis Colon Rectum . 1994;  37 824-828
• 23 Laureti S, Ugolini F, D'Errico A, Rago S, Poggioli G. Adenocarcinoma below ileoanal anastomosis for ulcerative colitis: report of a case and review of the literature.  Dis Colon Rectum . 2002;  45 418-421
• 24 Hyman N. Rectal cancer as a complication of stapled IPAA.  Inflamm Bowel Dis . 2002;  8 43-45
• 25 Rotholtz N A, Pikarsky A J, Singh J J, Wexner S D. Adenocarcinoma arising from along the rectal stump after double-stapled ileorectal J-pouch in a patient with ulcerative colitis: the need to perform a distal anastomosis. Report of a case.  Dis Colon Rectum . 2001;  44 1214-1217
• 26 Sequens R. Cancer in the anal canal (transitional zone) after restorative proctocolectomy with stapled ileal pouch-anal anastomosis.  Int J Colorectal Dis . 1997;  12 254-255
• 27 O'Connell P R, Pemberton J H, Weiland L H. et al . Does rectal mucosa regenerate after ileoanal anastomosis?.  Dis Colon Rectum . 1987;  30 1-5
• 28 Ziv Y, Fazio V W, Church J M, Lavery I C, King T M, Ambrosetti P. Stapled ileal pouch anal anastomoses are safer than handsewn anastomoses in patients with ulcerative colitis.  Am J Surg . 1996;  171 320-323
• 29 McIntyre P B, Pemberton J H, Beart R J, Devine R M, Nivatvongs S. Double-stapled vs.  handsewn ileal pouch-anal anastomosis in patients with chronic ulcerative colitis. Dis Colon Rectum . 1994;  37 430-433
• 30 Choen S, Tsunoda A, Nicholls R J. Prospective randomized trial comparing anal function after hand sewn ileoanal anastomosis with mucosectomy versus stapled ileoanal anastomosis without mucosectomy in restorative proctocolectomy.  Br J Surg . 1991;  78 430-434
• 31 Gemlo B T, Belmonte C, Wiltz O, Madoff R D. Functional assessment of ileal pouch-anal anastomotic techniques.  Am J Surg . 1995;  169 137-142
• 32 Holdsworth P J, Johnston D. Anal sensation after restorative proctocolectomy for ulcerative colitis.  Br J Surg . 1988;  75 993-996
• 33 Johnston D, Holdsworth P J, Nasmyth D G. et al . Preservation of the entire anal canal in conservative proctocolectomy for ulcerative colitis: a pilot study comparing end-to-end ileo-anal anastomosis without mucosal resection with mucosal proctectomy and endo-anal anastomosis.  Br J Surg . 1987;  74 940-944
• 34 Reilly W T, Pemberton J H, Wolff B G. et al . Randomized prospective trial comparing ileal pouch-anal anastomosis performed by excising the anal mucosa to ileal pouch-anal anastomosis performed by preserving the anal mucosa.  Ann Surg . 1997;  225 666-676
• 35 Saigusa N, Kurahashi T, Nakamura T. et al . Functional outcome of stapled ileal pouch-anal canal anastomosis versus handsewn pouch-anal anastomosis.  Surg Today . 2000;  30 575-581