Document Detail


Chronic inflammatory changes in the anal transition zone after stapled ileal pouch-anal anastomosis: is mucosectomy a superior alternative?
MedLine Citation:
PMID:  18847636     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Chronic inflammation (CI) is commonly found in the anal transition zone (ATZ) after stapled ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). Yet, its impact on defecatory function and the need for a complete mucosectomy has not been completely elucidated. This study aims to evaluate the long-term functional outcomes of patients with CI of the ATZ after stapled IPAA in comparison with mucosectomy patients. METHODS: Between June 1987 and November 2007, 66 UC patients were found to have CI of the ATZ after stapled IPAA and were compared with 228 UC patients who underwent mucosectomy with hand-sewn (HS) IPAA. Patients were mailed a questionnaire to assess defecatory function and quality of life. Data were analyzed prospectively. RESULTS: No differences were observed in age, sex, number, or consistency of bowel movements (BMs) between groups. Complete continence was reported by 90.3% of CI and 66.8% of HS patients (P < .001). The CI group also had a significantly lower rate of major incontinence (P < .001). Functional parameters in favor of the CI group included the ability to discriminate between gas and stool (P < .001), the use of protective pads during both the day and the night (P < .001), dietary modifications in the timing of meals (P < .001) and type of food (P = .005), and the presence of perianal rash (P = .019). In the CI group, more patients rated their quality of life as improved from before the operation (P < .001). CONCLUSIONS: Preservation of the ATZ, even in presence of persistent inflammation, confers improved continence, better functional outcomes, and superior quality of life.
Authors:
Mark T Silvestri; Roger D Hurst; Michele A Rubin; Fabrizio Michelassi; Alessandro Fichera
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Surgery     Volume:  144     ISSN:  1532-7361     ISO Abbreviation:  Surgery     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-10-13     Completed Date:  2008-11-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  533-7; discussion 537-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, University of Chicago, Chicago, IL, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Distribution
Anal Canal / pathology*
Anastomosis, Surgical / adverse effects,  methods
Chronic Disease
Cohort Studies
Colectomy / adverse effects,  methods
Colitis, Ulcerative / pathology,  surgery*
Colonic Pouches / pathology
Fecal Incontinence / epidemiology,  etiology
Female
Follow-Up Studies
Humans
Incidence
Intestinal Mucosa / surgery
Male
Middle Aged
Pouchitis / epidemiology,  pathology*
Probability
Prospective Studies
Quality of Life*
Risk Assessment
Sex Distribution
Surgical Stapling / adverse effects*
Suture Techniques
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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