Pelvic pouch-anal anastomoses: pros and cons about omission of mucosectomy and loop ileostomy. A study of 60 patients.

Pelvic pouches were constructed in 60 consecutive patients from 1987 to 1991. The first 30 patients underwent mucosectomy and construction of handsewn reservoirs, and ileoanal anastomoses protected by loop ileostomy (group A). In the following 12 patients (group B1) J pouches and ileoanal anastomoses were constructed by total stapling technique without mucosectomy, with a loop ileostomy. In the last 18 patients the loop ileostomy was omitted (group B2). A comparison between group A and B and between group B1 and B2 was made concerning anaesthesia time, hospital stay, blood transfusions, postoperative complications and pouch function at 2 and 12 months. It was found that the stapling technique (group B) reduced anaesthesia time considerably and reduced the need of blood transfusions. Postoperatively thromboembolic episodes and signs of adrenal insufficiency were seen only in the handsewn group, while postoperative febrile conditions were more common in the stapled groups. Ileo-anal dehiscence occurred in two patients without loop ileostomy. Treatment by establishment of a loop ileostomy, local irrigation and administration of antibiotics were successful, the anastomoses healed within 2 weeks and there was no further complications before or after loop closure. Omitting the loop ileostomy saved the patient a further operation and reduces hospital stay and sick leave. After two months of pouch function, patients with handsewn pouches had a lower number of bowel movements (5.5/24 h and 0.8 during the night) than patients with stapled pouches (8.0/24 h and 1.9 during the night). At 12 months, however, the difference between the groups of patients had diminished.(ABSTRACT TRUNCATED AT 250 WORDS)