Clinicopathological study of anorectal mucosa in total colectomy with mucosal proctectomy and ileoanal anastomosis.

OBJECTIVE

To find out whether the extent of inflammation of the anorectal mucosa affects the quality of the mucosectomy and postoperative function in patients undergoing total colectomy with mucosal proctectomy and ileoanal anastomosis.

DESIGN

Prospective study.

SETTING

University hospital.

SUBJECTS

33 patients with ulcerative colitis and 17 with familial adenomatous polyposis.

INTERVENTIONS

With the patient in the prone jackknife position, the anorectal columnar mucosa above the dentate line was removed transanally by the forceps coagulation technique.

MAIN OUTCOME MEASURES

Score of histological appearance on light microscopy.

RESULTS

All the patients with ulcerative colitis had moderate (n = 17, 52%) or severe (n = 16, 48%) inflammation, and their mean histological score was 12 (range 7-16). The patients with polyposis had little or no inflammation, and a mean histological score of 0.4 (range 0-2). The mucosectomy became more difficult as the severity of the inflammation increased, but there were no significant differences between the two groups in operating time, blood loss, or bowel function postoperatively.

CONCLUSION

Though mucosectomy is technically more difficult in the presence of severe inflammation, there were no adverse effects on bowel function postoperatively.