Manometric follow-up of anal sphincter function after an ileo-anal pouch procedure

Between January 1985 and January 1987 restorative proctocolectomy with J-pouch was undertaken in 20 patients with ulcerative colitis. In all patients anal manometry was performed preoperatively, before closure of the temporary ileostomy (mean 3.9 months after operation) and 3,6 and 12 months after the closure of the ileostomy. Preoperatively the basal resting pressure was 60.2 +/- 12 cm water and the maximum squeeze pressure 88.5 +/- 18 cm water. After the operation the respective pressures were 33.2 +/- 8 and 68 +/- 21 cm water, a decrease of 45% (p less than 0.05) and 12% (p less than 0.05), respectively. One year after the closure of the loop ileostomy the basal pressure was 46.2 +/- 9 cm water, which is still 23% lower (p less than 0.05) than preoperatively. At the same time the maximum squeeze pressure was 96.5 +/- 13 cm water, 8% higher (p greater than 0.1) than preoperatively. The continence of the patients at the end of the follow-up was either good (n = 6) or excellent (n = 9). A correlation seemed to exist between sphincter pressures and the degree of continence. It is concluded that the internal anal sphincter suffers damage during the operation and slowly recovers up to 6 months after closure of the covering ileostomy. After that its function usually does not improve and remains at a lower level than preoperatively.