Ileal reservoir anal anastomosis

Abstract

Ileal pouch anal anastomosis (IPAA) after proctocolectomy has a technically difficult surgical procedure in addition to the complications of loop anastomosis and pouchitis. A simplified technique of pouch construction is presented. Eight patients were operated on (age 38.2 years; 5 women, 3 men) for ulcerative colitis (n=5) and familial polyposis (n=3). Proctocolectomy was performed and a neorectum constructed. An ileal segment of 50 cm was aligned so that 3 loops lay horizontally one above the other. Serosal sutures approximated each 2 adjacent limbs. Myectomy, 1×10 cm, was performed in each limb. Ileoanal anastomosis was then done. Patients were followed for a mean of 21.3 months. Multiple mucosal tears occurred in the first 3 patients and were sutured. No anastomotic leak occurred; ileoanal anastomotic stenosis occurred in 1 case. Patients were continent. Mean stool frequency 18 months postoperatively was 3.4±0.9 during the day and 1.1±0.3 during night-time. The mean reservoir capacity 6 months after operation was 686.3±72.5 ml. Pouchometry displayed a horizontal plateau with fluctuations. Fecoflowmetry produced a curve full of fluctuations. In conclusion, the presented technique seems to be easier and has less complications than the other procedures used for pouch construction. Meanwhile, it achieves the functional results of continence and less frequent evacuations.