The ileo neo rectal anastomosis: long-term results of surgical innovation in patients after ulcerative colitis and familial adenomatous polyposis.

Autor: Heikens JT; Department of Surgery, Radboud University Nijmegen Medical Centre, Route 690, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands. j.heikens@chir.umcn.nl, Gooszen HG, Teepen JL, Hueting WE, Oostvogel HJ, van Vroonhoven TJ, van Krieken JH, van Laarhoven CJ
Jazyk: angličtina
Zdroj: International journal of colorectal disease [Int J Colorectal Dis] 2013 Jan; Vol. 28 (1), pp. 111-8. Date of Electronic Publication: 2012 Aug 12.
DOI: 10.1007/s00384-012-1545-0
Abstrakt: Purpose: Restorative proctocolectomy with ileo neo rectal anastomosis (INRA) combines cure of ulcerative colitis (UC) or familial adenomatous polyposis (FAP) with restoration of intestinal continuity. Evaluation of long-term results was needed to determine if there is a place for INRA in the armamentarium of a surgeon besides the ileal pouch anal anastomosis (IPAA).
Methods: All patients with INRA were included in the analysis. Patient demographics and clinical and follow-up data (morbidity, dietary problems, defecation frequency, fecal continence, anal and neorectal physiology, and neorectal mucosa assessment) were registered prospectively.
Results: Seventy-nine patients were enrolled, and in 58 patients (50 UC, 8 FAP), INRA was successful. In 21 patients, intraoperative conversion to IPAA was needed. In 49 patients with INRA, a functional reservoir was achieved. No pelvic sepsis or bladder or sexual dysfunction occurred. Thirteen patients experienced episodes of reservoir inflammation. Median bowel movements of six (5, 8) with a nocturnal defecation frequency of one were recorded with fecal continence or minor incontinence. Anal manometry and neorectal physiology showed a decrease in resting pressure and an increase in squeeze pressure and maximum tolerated volume. The median follow-up was 8.1 years (6.7, 10.1).
Conclusions: This is an example of a surgical innovation with a theoretical potential to be superior to the current technique. This potential was not confirmed in short- and long-term evaluations. Hence, IPAA is currently the best available alternative to a conventional ileostomy.
Databáze: MEDLINE
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