Randomised trial to determine the optimum level of pouch-anal anastomosis in stapled restoractive proctocolectomy
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Date
1995
Journal Title
Journal ISSN
Volume Title
Publisher
Lippincott Williams and Wilkins
Abstract
PURPOSE:This study was undertaken to identify the optimum level of stapled ileal pouch-anal anastomosis. METHOD: A prospective, randomized trial was completed to compare double-stapled ileoanal anastomosis placed at the top of anal columns (high, n = 26) with anastomosis at the dentate line (low, n = 21). RESULTS: There was no significant difference in the overall complication rate between operations (high, n = 7, vs. low, n = 8; P < 0.21). Pouch-anal functional score (scale 0-12; 0 = excellent, 12 = poor) was significantly better in the high anastomosis group (median (range): 2 (1-9) vs. 5.5 (1-12); P < 0.05). Incontinence occurred in only two patients randomized to high anastomosis compared with six in the low anastomosis group. Nocturnal soiling was reported in three patients after high anastomosis and in six patients after dentate line anastomosis. Both operations caused a significant but comparable reduction of maximum and resting pressure (31 percent after high anastomosis (P < 0.05); 23 percent after low anastomosis (P < 0.05)). However, a significant fall in functional length of the anal canal was only seen after a low pouch-anal anastomosis (P < 0.05). CONCLUSION: Stapled pouch-anal anastomosis at the top of anal columns gives better functional results compared with a stapled anastomosis at the dentate line.
Description
Indexed in MEDLINE
Keywords
Clinical Trial, Randomized Controlled Trial, Anal Canal-surgery, Anastomosis, Surgical-adverse effects, Colitis, Ulcerative-surgery, Ileostomy, Ileum-surgery, Proctocolectomy, Restorative-methods
Citation
Disease of the Colon and Rectum. 1995; 38(2): pp.133-138