The single-stapled ileo pouch anal anastomosis: a reasonable compromise

Minimal anal sphincter disruption and preservation of the transitional epithelium during ileal pouch anal anastomosis (IPAA) are believed to play important roles in improving functional outcome. As a result, many surgeons have abandoned the traditional mucosectomy in favor of a double-stapled technique. The natural history of the retained colonic epithelium that occurs with this approach is uncertain. The authors have employed a technique of single circular-stapled IPAA, which accomplishes both of the described goals, while insuring that all the colonic mucus is removed during mucosectomy. We present a series of patients (n = 39) undergoing IPAA with transanal mucosectomy and a circular stapled anastomosis. The series consists of 16 males and 23 females with a mean age of 33.4 +/- 1.7 years. Twenty-nine patients had temporary ileostomies (2 not closed yet), and 10 did not. Pelvic sepsis occurred in two patients. However, three (9%) patients developed anastomotic sinus tracts that delayed ileostomy closure. With a follow-up of 24.0 +/- 3.2 months, the mean number of bowel movements are: day 6.4 +/- 0.4; night 1.1 +/- 0.2. Continence has been good or excellent in 97 per cent of patients during the day and 86 per cent at night. Therefore, this series indicates that good to excellent functional results following IPAA in the vast majority of patients can be accomplished with a transanal mucosectomy and a single stapled IPAA anastomotic technique. These results are comparable with those obtained with the double stapling technique without risk of retained rectal mucosa. Therefore, this technique provides good functional results because of minimal anal sphincter stretching, while at the same time insuring removal of all abnormal colonic epithelium.