Differences in ano‐neorectal physiology of ileoanal and coloanal reconstructions for restorative proctectomy

Rink, Andreas D.; Kneist, W.; Radinski, I; Guinot-Barona, A.; Lang, Hauke; Vestweber, Karl-Heinz

doi:10.1111/j.1463-1318.2009.01790.x

Cited by 17 publications

(5 citation statements)

References 30 publications

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“…The patients with poorly functioning IPAA had a higher prevalence of inflammation, both macro-and microscopically [20]. Other studies related good pouch function to a higher compliance of the pouch wall as well as better sphincter functions measured with manometric studies [21,22]. Since no manometric studies were performed in our study, we could not comment on neither volume differences inside the pouches nor on the sphincter functions.…”

Section: Association Between Macroscopic and Microscopic Grades Of Inmentioning

confidence: 64%

Anorectal Function After Ileo-Rectal Anastomosis Is Better than Pelvic Pouch in Selected Ulcerative Colitis Patients

et al. 2019

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Background With a lifelong perspective, 12% of ulcerative colitis patients will need a colectomy. Further reconstruction via ileo-rectal anastomosis or pouch can be affected by patients' perspective of their quality of life after surgery. Aim To assess the function and quality of life after restorative procedures with either ileo-rectal anastomosis or ileal pouchanal anastomosis in relation to the inflammatory activity on endoscopy and in biopsies. Method A total of 143 UC patients operated with subtotal colectomy and ileo-rectal anastomosis or pouches between 1992 and 2006 at Linköping University Hospital were invited to participate. Those who completed the validated questionnaires (Öresland score, SF-36, Short Health Scale) were offered an endoscopic evaluation including multiple biopsies. Associations between anorectal function and quality of life with type of restorative procedure and severity of endoscopic and histopathologic grading of inflammation were evaluated. Results Some 77 (53.9%) eligible patients completed questionnaires, of these 68 (88.3%) underwent endoscopic evaluation after a median follow-up of 12.5 (range 3.5-19.4) years after restorative procedure. Patients with ileo-rectal anastomosis reported better overall Öresland score: median = 3 (IQR 2-5) for ileo-rectal anastomosis (n = 38) and 10 (IQR 5-15) for pouch patients (n = 39) (p < 0.001). Anorectal function (Öresland score) and endoscopic findings (Baron-Ginsberg score) were positively correlated in pouch patients (tau: 0.28, p = 0.006). Conclusion Patients operated with ileo-rectal anastomosis reported better continence compared to pouches. Minor differences were noted regarding the quality of life. Ileo-rectal anastomosis is a valid option for properly selected ulcerative colitis patients if strict postoperative endoscopic surveillance is carried out. Keywords Ulcerative colitis • Ileo-rectal anastomosis • Ileal pouch-anal anastomosis • Quality of life Abbreviations BG Baron-Ginsberg score CCGQoL Cleveland clinic global quality of life score IBD Inflammatory bowel disease IPAA Ileal pouch-anal anastomosis IRA Ileo-rectal anastomosis IQR Interquartile range OR Odds ratio SF-36 Short form 36 questions SHS Short health scale tau Kendall-tau correlation coefficient UC Ulcerative colitis VAS Visual analogue scale QoL Quality of life Electronic supplementary material The online version of this article (

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Section: Association Between Macroscopic and Microscopic Grades Of Inmentioning

confidence: 64%

Anorectal Function After Ileo-Rectal Anastomosis Is Better than Pelvic Pouch in Selected Ulcerative Colitis Patients

et al. 2019

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“…Furthermore, post-treatment function depends on the surgical procedure, the use of adjuvant treatment, level of anastomosis, presence of an intestinal reservoir, the need for a temporary stoma and the suture technique [41][42][43]. For this reason the six studies of restorative proctocolectomy with ileal reservoir were not included in the present study [44][45][46][47][48][49] and greater attention was given to function during the early period of recovery and in the long-term follow-up [50].…”

Section: Discussionmentioning

confidence: 99%

Treatment options to improve anorectal function following rectal resection: a systematic review

Maris

Devreese

D’Hoore³

et al. 2013

Colorectal Disease

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“…A previous study pointed out that TME for rectal cancer patients could result in postoperative fecal incontinence combined with urinary incontinence [11]. The anal continence is closely related to the function of the IAS which is controlled by pelvic autonomic nerves [20,21]. In this regard, an animal study has been conducted to evaluate the IAS as a target organ for an intraoperative neuromonitoring of PANP.…”

Section: Discussionmentioning

confidence: 99%

Selective Pelvic Autonomic Nerve Stimulation with Simultaneous Intraoperative Monitoring of Internal Anal Sphincter and Bladder Innervation

et al. 2011

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Background: Pelvic autonomic nerve preservation avoids postoperative functional disturbances. The aim of this feasibility study was to develop a neuromonitoring system with simultaneous intraoperative verification of internal anal sphincter (IAS) activity and intravesical pressure. Methods: 14 pigs underwent low anterior rectal resection. During intermittent bipolar electric stimulation of the inferior hypogastric plexus (IHP) and the pelvic splanchnic nerves (PSN), electromyographic signals of the IAS and manometry of the urinary bladder were observed simultaneously. Results: Stimulation of IHP and PSN as well as simultaneous intraoperative monitoring could be realized with an adapted neuromonitoring device. Neurostimulation resulted in either bladder or IAS activation or concerted activation of both. Intravesical pressure increase as well as amplitude increase of the IAS neuromonitoring signal did not differ significantly between stimulation of IHP and PSN [6.0 cm H₂O (interquartile range [IQR] 3.5–9.0) vs. 6.0 cm H₂O (IQR 3.0–10.0) and 12.1 µV (IQR 3.0–36.7) vs. 40.1 µV (IQR 9.0–64.3)] (p > 0.05). Conclusions: Pelvic autonomic nerve stimulation with simultaneous intraoperative monitoring of IAS and bladder innervation is feasible. The method may enable neuromonitoring with increasing selectivity for pelvic autonomic nerve preservation.

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Differences in ano‐neorectal physiology of ileoanal and coloanal reconstructions for restorative proctectomy

Cited by 17 publications

References 30 publications

Anorectal Function After Ileo-Rectal Anastomosis Is Better than Pelvic Pouch in Selected Ulcerative Colitis Patients

Anorectal Function After Ileo-Rectal Anastomosis Is Better than Pelvic Pouch in Selected Ulcerative Colitis Patients

Treatment options to improve anorectal function following rectal resection: a systematic review

Selective Pelvic Autonomic Nerve Stimulation with Simultaneous Intraoperative Monitoring of Internal Anal Sphincter and Bladder Innervation

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