The ileo-anal reservoir: results from an evolving use of stapling devices

Thirteen patients had a hand-sewn pouch-anal anastomosis (group A) during restorative proctocolectomy for familial adenomatous polyposis. Median length of follow-up since ileostomy closure was 41.5 months (range 30-56 months). Median stool frequency per 24 h was 4.5 (range 2-5). Six patients were fully continent, three were incontinent to flatus and three patients were occasionally incontinent to liquid stool. Three patients suffered nocturnal seepage but all patients could defer the urge to defaecate by at least 15 min. Fourteen patients (familial adenomatous polyposis: seven; ulcerative colitis: six; intractable constipation: one), had a totally stapled ileal J pouch and pouch-anal anastomosis (group B). Five patients did not have a defunctioning ileostomy while nine patients did. Median follow-up after ileostomy closure or one-stage restorative proctocolectomy was 17.5 months (range 1-30 months). Median frequency of bowel movement per 24 h was 4 (range 2-6). Eleven patients had full continence and three patients suffer occasional incontinence to liquid stools. Two patients have nocturnal seepage but all can defer the urge to defaecate by more then 15 min. There was no significant difference in physiological parameters between the two groups.