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Anal sensation after restorative proctocolectomy for ulcerative colitis
1University Department of Surgery, General Infirmary, Leeds, UK.
The British Journal of Surgery
|October 1, 1988
Summary
Restorative proctocolectomy with end-to-end ileoanal anastomosis (RP + EEA) offers superior anal sensation and continence compared to mucosal proctectomy with endo-anal anastomosis (MP + EAA). Patients undergoing RP + EEA demonstrated better discrimination and reflex control.
Area of Science:
- Colorectal Surgery
- Surgical Outcomes
- Anal Physiology
Background:
- Restorative proctocolectomy (RP) techniques aim to preserve anal function.
- Comparing end-to-end ileoanal anastomosis (EEA) with mucosal proctectomy and endo-anal anastomosis (EAA) is crucial for optimizing surgical outcomes.
- Understanding the impact of surgical technique on anal sensation is vital for patient quality of life.
Purpose of the Study:
- To compare anal sensation and continence after restorative proctocolectomy with end-to-end ileoanal anastomosis (RP + EEA) versus mucosal proctectomy with endo-anal anastomosis (MP + EAA).
- To evaluate the 'recto'-anal inhibitory reflex and the ability to discriminate between flatus and feces post-operatively.
Main Methods:
- Anal sensation was assessed using threshold electrosensitivity measurements in the upper, mid, and lower anal canal.
- The 'recto'-anal inhibitory reflex was tested in patients.
- Patient-reported outcomes regarding flatus discrimination and safe flatus passage were collected via interview.
Main Results:
- Threshold electrosensitivity in the upper anal canal was significantly greater after MP + EAA compared to RP + EEA (P < 0.05).
- No significant differences in electrosensitivity were found in the mid and lower anal canal.
- The 'recto'-anal reflex was regained in 75% of RP + EEA patients versus 23% of MP + EAA patients (P < 0.02).
- Safe flatus passage was reported by 13 RP + EEA patients compared to 4 MP + EAA patients (P < 0.02).
Conclusions:
- Restorative proctocolectomy with end-to-end ileoanal anastomosis results in significantly better anal sensation and discriminatory function compared to mucosal proctectomy with endo-anal anastomosis.
- RP + EEA is associated with improved recovery of the 'recto'-anal inhibitory reflex and enhanced ability for safe flatus passage.
- Surgical technique significantly influences post-operative anal function and patient continence outcomes.