Does balloon dilatation and anal sphincter training improve ileoanal-pouch function?

Abstract

Although patients' satisfaction may be high after restorative proctocolectomy the functional results are still far from perfect. Increased bowel frequency and imperfection in continence are common. Pouch volume and anal sphincter status are important determinants for the outcome. The aim of the present study was to evaluate if balloon dilatation of the pouch and sphincter biofeedback training might improve the results. Forty patients with an ileo-pouch anal anastomosis were randomized into a control and a treatment group. During the interval with a diverting ileostomy, patients in the latter group were subjected to balloon dilatation of the pouch and sphincter biofeedback training by using a manovolumetric technique. All patients were functionally assessed and anorectal manovolumetry performed preoperatively and at regular intervals postoperatively. Follow-up time was at least 12 months. Immediately before ileostomy take down patients in the treatment group showed a significant initial increase in pouch compliance compared with controls. However, a rapid and pronounced increase in pouch volume occurring after ileostomy closure in the control group equalized this initial difference. Anal resting tone and maximum squeezing capacity were at all intervals similar in the two groups. Bowel frequency per 24 h was similar and mucus soiling occurred to a similar extent in both groups, and the overall functional result as assessed according to a scoring system was equal at each interval. Balloon dilatation of the pouch and sphincter exercises appear not to be essential measures in these patients.