Akira Sugita1, Kazutaka Koganei2, Kenji Tatsumi2, Ryo Futatsuki2, Hirosuke Kuroki2, Kyoko Yamada2, Hideaki Kimura3, Tsuneo Fukushima4. 1. Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56 Okazawa cho, Hodogaya ward, Yokohama, 240-8555, Japan. sugita-ymhp@mua.biglobe.ne.jp. 2. Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen's Hospital, 56 Okazawa cho, Hodogaya ward, Yokohama, 240-8555, Japan. 3. Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan. 4. Matsushima Clinic, Yokohama, Japan.
Abstract
AIM: For ulcerative colitis (UC), stapled ileal pouch anal anastomosis (IPAA) reportedly results in better bowel function than does IPAA with mucosectomy. However, a potential cancer risk in the remnant mucosa has been observed. The clinical results of IPAA by double stapling technique (DS-IPAA) in which the anastomotic line was on the dentate line at posterior wall and the top of anal canal at anterior wall ("Partially intraanal canal anastomosis": PICA) to reduce the remnant mucosa were evaluated. METHODS: Clinical results of PICA were retrospectively compared with those by DS-IPAA with anastomosis at above the anal canal on 1 year after open surgery. Of 211 UC cases that underwent DS-IPAA, 146 cases (69%) with PICA who were confirmed by the squamous epithelium on the posterior part of the distal donuts were included. Sixty-five cases with anastomosis above the anal canal were evaluated as the control. One stage surgery underwent in 95% of PICA and 93% of control. RESULTS: One year after surgery, each group had six bowel movements daily. Nighttime evacuation was found in 16% of PICA and in 20% of control. Soiling was found in 1% of PICA and 4.8% of control. After one stage operation, anastomotic leakage that needed ileostomy was observed in 0.7% of PICA and 3% of control. CONCLUSION: Partially intraanal canal anastomosis (PICA) can reduce anal canal mucosa with the same postoperative bowel function and complication rate as DS-IPAA above the anal canal. This procedure may be feasible for UC patients who can tolerate this procedure in terms of decreasing postoperative cancer risk.
AIM: For ulcerative colitis (UC), stapled ileal pouch anal anastomosis (IPAA) reportedly results in better bowel function than does IPAA with mucosectomy. However, a potential cancer risk in the remnant mucosa has been observed. The clinical results of IPAA by double stapling technique (DS-IPAA) in which the anastomotic line was on the dentate line at posterior wall and the top of anal canal at anterior wall ("Partially intraanal canal anastomosis": PICA) to reduce the remnant mucosa were evaluated. METHODS: Clinical results of PICA were retrospectively compared with those by DS-IPAA with anastomosis at above the anal canal on 1 year after open surgery. Of 211 UC cases that underwent DS-IPAA, 146 cases (69%) with PICA who were confirmed by the squamous epithelium on the posterior part of the distal donuts were included. Sixty-five cases with anastomosis above the anal canal were evaluated as the control. One stage surgery underwent in 95% of PICA and 93% of control. RESULTS: One year after surgery, each group had six bowel movements daily. Nighttime evacuation was found in 16% of PICA and in 20% of control. Soiling was found in 1% of PICA and 4.8% of control. After one stage operation, anastomotic leakage that needed ileostomy was observed in 0.7% of PICA and 3% of control. CONCLUSION: Partially intraanal canal anastomosis (PICA) can reduce anal canal mucosa with the same postoperative bowel function and complication rate as DS-IPAA above the anal canal. This procedure may be feasible for UC patients who can tolerate this procedure in terms of decreasing postoperative cancer risk.
Authors: Richard E Lovegrove; Vasilis A Constantinides; Alexander G Heriot; Thanos Athanasiou; Ara Darzi; Feza H Remzi; R John Nicholls; Victor W Fazio; Paris P Tekkis Journal: Ann Surg Date: 2006-07 Impact factor: 12.969
Authors: Feza H Remzi; Victor W Fazio; Conor P Delaney; Miriam Preen; Adrian Ormsby; Jane Bast; Michael G O'Riordain; Scott A Strong; James M Church; Robert E Petras; Terry Gramlich; Ian C Lavery Journal: Dis Colon Rectum Date: 2003-01 Impact factor: 4.585