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Pouch function assessment with dynamic magnetic resonance defecography after ileal pouch anal anastomosis for
Jiansheng Wang1, Yi Xu1, Tenghui Zhang1
1Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Background:
Ulcerative colitis (UC) patients undergoing ileal pouch anal anastomosis (IPAA) will potentially have abnormal pouch function, which seriously affects their quality of life. It is usually attributed to postoperative pouch structural complications. However, symptoms of poor pouch function also occur in patients with "normal pouch". Few objective tools have been used to evaluate the pouch function with non-optimal pouch physiology.
Aim:
To investigate the validity of dynamic magnetic resonance defecography (DMRD) and its relationship with pouch function in UC patients undergoing IPAA.
Methods:
UC patients who had IPAA surgery were recruited. Patients with structural complications were excluded. Patients were assessed by questionnaires for pouch function including ileal pouch syndrome severity (IPSS) score. DMRD was performed at resting, raising, and defecation phase. The correlation between DMRD data and pouch function was investigated. Poor pouch function was defined as IPSS score >15.
Results:
A total of 33 patients were included. The results showed that distance from anastomosis to pubococcygeal line (PCL) at rest phase was an independent risk factor for poor pouch function ([OR] 5.65, 95 % CI 1.02-31.16, P = 0.047). The length of cuff at raising phase was an independent risk factor for urgency ([OR] 12.55, 95 % CI 1.06-148.32, P = 0.045). In addition, M-line length-a reference for assessing pelvic floor descent (normal ≤2 cm)-during defecation was an independent risk factor for incomplete defecation ([OR] 2.47, 95 % CI 1.11-5.47, P = 0.027), while M-line length at rest was an independent risk factor for stool leakage ([OR] 10.16, 95 % CI 1.15-90.07, P = 0.037).
Conclusions:
Magnetic resonance defecography is a potentially useful imaging modality for evaluating pouch function. Our study presented a series of DMRD parameters for functional assessment and their association with defecation disorders during dynamic monitoring. Therefore, DMRD provides information, in addition to clinical parameters, in symptomatic pouch patients.
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