Mucosal proctectomy with straight ileoanal anastomosis. A comparison of two methods.

Straight ileoanal anastomosis was performed in 59 patients. In 32 patients (group I) mucosal dissection was performed from above with preservation of a distal mucosal brim. In 27 patients (group II) the mucosectomy was performed to the dentate line--in 26 patients from the perineal side and in 1 patient from the abdominal side. Diverting loop ileostomy was used in group II but not in group I. The results in group II were in every respect inferior to those in group I, with significantly more intestinal obstruction and more conversions to permanent ileostomy because of poor functional results. The patients with ulcerative colitis (UC) in group II had higher stool frequency (10 (6-12) versus 7.3 (5-8) per 24 h; p = 0.01) and significantly less 'neorectal' capacity and distensibility than the UC patients in group I at 12 months after the operation. Anal continence was perfect in group I. In group II, 5 of 15 of the patients had significant incontinence problems 12 months postoperatively. The differences in results are ascribed to the differences in surgical technique between the two groups, and especially to the harmful effect of anal dilatation.