Extent of smooth muscle resection during mucosectomy and ileal pouch-anal anastomosis affects anorectal physiology and functional outcome

Diseases of the Colon and Rectum
J M BeckerS Ferzoco

Abstract

In patients undergoing colectomy with ileal pouch-anal anastomosis, controversy exists regarding the necessity for and appropriate extent of rectal mucosal resection. Our aim was to assess histologically the extent of anorectal smooth muscle resected at the time of mucosal proctectomy and to correlate this with postoperative bowel and anal sphincter function. Surgical specimens of 79 patients undergoing colectomy, mucosal proctectomy, and ileal pouch-anal anastomosis were examined histologically in a blinded fashion, and the content of smooth muscle in the mucosal proctectomy specimens was scored. Degree of smooth muscle resection was correlated with postoperative anorectal manometry and with functional outcomes, including stool frequency and nocturnal leakage of stool after 3 and 12 months of follow-up. Degree of smooth muscle loss correlated with decreased resting pressure of the internal anal sphincter as early as three months after surgery (r = -0.26; P = 0.03), and the correlation was even stronger after 12 months (r = -0.37; P = 0.005). Decreases in resting pressure were related, in turn, to increased stool frequency at 12 months (r = 0.32; P = 0.02), but stool frequency was also inversely related to volume of the ileal p...Continue Reading

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Citations

Apr 29, 2008·International Journal of Colorectal Disease·Andreas D RinkKarl-Heinz Vestweber
Oct 8, 2003·Annals of Surgery·Victor W FazioConor P Delaney
Feb 27, 2003·Southern Medical Journal·Jules E GarbusSteven D Wexner
May 17, 2007·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·W M Chambers, N J McC Mortensen
Feb 12, 2009·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·A D RinkK H Vestweber
Feb 14, 2012·Journal of Crohn's & Colitis·Bo ShenMichael W Kattan
Sep 6, 2006·Gastroenterology Clinics of North America·Arthur F StucchiJames M Becker
Nov 17, 1998·American Journal of Surgery·M D Levitt, M Kuan
Sep 9, 2017·World Journal of Gastroenterology : WJG·Se Heon OhJin Cheon Kim
Apr 8, 2017·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·A L LightnerK L Mathis
Dec 7, 2018·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·S R BrownUNKNOWN ACPGBI IBD Surgery Consensus Collaboration

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