OBJECTIVE: To find out whether the extent of inflammation of the anorectal mucosa affects the quality of the mucosectomy and postoperative function in patients undergoing total colectomy with mucosal proctectomy and ileoanal anastomosis. DESIGN: Prospective study. SETTING: University hospital. SUBJECTS: 33 patients with ulcerative colitis and 17 with familial adenomatous polyposis. INTERVENTIONS: With the patient in the prone jackknife position, the anorectal columnar mucosa above the dentate line was removed transanally by the forceps coagulation technique. MAIN OUTCOME MEASURES: Score of histological appearance on light microscopy. RESULTS: All the patients with ulcerative colitis had moderate (n = 17, 52%) or severe (n = 16, 48%) inflammation, and their mean histological score was 12 (range 7-16). The patients with polyposis had little or no inflammation, and a mean histological score of 0.4 (range 0-2). The mucosectomy became more difficult as the severity of the inflammation increased, but there were no significant differences between the two groups in operating time, blood loss, or bowel function postoperatively. CONCLUSION: Though mucosectomy is technically more difficult in the presence of severe inflammation, there were no adverse effects on bowel function postoperatively.
OBJECTIVE: To find out whether the extent of inflammation of the anorectal mucosa affects the quality of the mucosectomy and postoperative function in patients undergoing total colectomy with mucosal proctectomy and ileoanal anastomosis. DESIGN: Prospective study. SETTING: University hospital. SUBJECTS: 33 patients with ulcerative colitis and 17 with familial adenomatous polyposis. INTERVENTIONS: With the patient in the prone jackknife position, the anorectal columnar mucosa above the dentate line was removed transanally by the forceps coagulation technique. MAIN OUTCOME MEASURES: Score of histological appearance on light microscopy. RESULTS: All the patients with ulcerative colitis had moderate (n = 17, 52%) or severe (n = 16, 48%) inflammation, and their mean histological score was 12 (range 7-16). The patients with polyposis had little or no inflammation, and a mean histological score of 0.4 (range 0-2). The mucosectomy became more difficult as the severity of the inflammation increased, but there were no significant differences between the two groups in operating time, blood loss, or bowel function postoperatively. CONCLUSION: Though mucosectomy is technically more difficult in the presence of severe inflammation, there were no adverse effects on bowel function postoperatively.
Authors: P van Duijvendijk; H F Vasen; L Bertario; S Bülow; J H Kuijpers; W R Schouten; J G Guillem; C W Taat; J F Slors Journal: J Gastrointest Surg Date: 1999 May-Jun Impact factor: 3.452