Ileal pouch anal function after endoanal mucosectomy and handsewn ileoanal anastomosis compared with stapled anastomosis without mucosectomy.

OBJECTIVE

To compare manovolumetric results and functional outcome after restorative proctocolectomy with either mucosal proctectomy and handsewn pouch-anal anastomosis or stapling.

DESIGN

Prospective randomised study.

SETTING

University hospital, Sweden.

SUBJECTS

80 Consecutive patients undergoing restorative proctocolectomy.

INTERVENTIONS

37 patients were randomised to have mucosectomy and a handsewn anastomosis and 43 patients to have a stapled anastomosis.

MAIN OUTCOME MEASURES

Comparisons of anal sphincter function and clinical outcome in terms of continence and overall functional score between the two groups of patients.

RESULTS

There was persistent reduction in anal resting tone at one year amounting to 29% in the handsewn group and and to 21% in the stapled group (p < 0.001 compared with preoperative in both groups). Daytime continence was similar, but patients with stapled anastomoses experienced less soiling during sleep, especially in the early postoperative period (5/43, 12% compared with 15/33, 45% at one month, p < 0.001). The arbitrary overall functional score was, however, similar in both groups.

CONCLUSION

Handsewn and stapled ileal pouch-anal anastomoses result in similar postoperative anal sphincter impairment and overall clinical outcome.