Clinical and physiological evaluation of anorectal eversion during restorative proctocolectomy

Area of Science:

• Colorectal Surgery
• Gastroenterology
• Surgical Innovation

Background:

• Restorative proctocolectomy is a common procedure for ulcerative colitis and familial adenomatous polyposis.
• The eversion technique for ileoanal anastomosis is one method used in this surgery.
• Understanding the impact of surgical techniques on anal sphincter function is crucial for patient outcomes.

Purpose of the Study:

• To evaluate the effects of stapled end-to-end ileoanal anastomosis with the eversion technique on anal sphincter motor and sensory functions.
• To assess the functional outcomes, specifically anal continence, one year after restorative proctocolectomy.

Main Methods:

• Fifty patients underwent restorative proctocolectomy with stapled end-to-end ileoanal anastomosis using the eversion technique.
• Anal pressures (resting and squeeze) and sensory thresholds were measured before and one year after surgery.
• Patient continence and ability to discriminate between feces and flatus were assessed one year post-operatively.

Main Results:

• A significant decrease in maximum resting anal pressure was observed one year after surgery (P < 0.001).
• Maximum squeeze pressure showed no significant change post-surgery.
• Median sensory thresholds improved significantly (P = 0.006), and 84% of patients could discriminate between feces and flatus.
• All patients achieved continence, with only two reporting mucus leakage.

Conclusions:

• Eversion of the anorectum during restorative proctocolectomy can impair anal sphincter motor and sensory functions.
• Despite physiological changes, the eversion technique generally leads to satisfactory anal continence in most patients.
• Further research may explore modifications to preserve sphincter function while maintaining continence.