Endosonography of the anal sphincter after ileal pouch-anal anastomosis

Abstract

IPAA leads to a reduction of thickness of the internal anal sphincter and reduction of the MRP. Tapering or gaps in the internal anal sphincter are probably caused by direct trauma to this sphincter because of mucosectomy, whereas in cases of circular reduction of thickness of the internal anal sphincter without tapering or gaps, direct trauma is an unlikely explanation; this reduction is probably caused by denervation. IPAA compromises continence to a variable degree in 18 of 23 patients. No correlations were found between the extent of reduction of the MRP and the extent of reduction in internal anal sphincter thickness or between these two parameters and objectively or subjectively scored continence. Difficulties in obtaining reliable information on continence may be a causal factor. A striking discrepancy was noticed among objective, scored disturbances in continence, and overall satisfaction concerning level of continence by patients themselves.

Reconstructive Surgery for Failed Ileal Pouch-Anal Anastomosis

“…The decreased continence likely relates to repeated sphincter trauma, 26,27 and may also be in part attributable to the mucosectomy and handsewn anastomosis required in the reconstruction group, which some authors believe contributes to decreased continence, 28,29 although this is disputed by others. [30][31][32] The increased number of bowel movements may be secondary to decreased total small bowel length in those patients who underwent pouch excision with construction of a new pouch.…”

Integrity of the Anal Sphincters After Pouch-Anal Anastomosis: Evaluation With Three-Dimensional Endoanal Ultrasonography

“…[15][16][17][18] Only one 2D EUS study has been conducted to examine the morphology of both sphincters after transanal mucosectomy followed by an IPAA hand-sutured at the level of the dentate line. 19 The present study is the first one to use 3D EUS before and after surgery to evaluate the impact of transanal mucosectomy followed by a handsewn pouch-anal anastomosis on the integrity and the morphology of both sphincters. Unlike 2D EUS, 3D EUS produces a digital volume that may be reviewed and used to perform measurements in any plane.…”

“…Until now, four EUS studies have been performed in patients with a transanally stapled low colorectal anastomosis, [15][16][17][18] and only one in patients with a handsewn IPAA. 19 The present study is the first one to use 3D EUS before and after surgery to evaluate the impact of transanal mucosectomy followed by handsewn pouch-anal anastomosis at the level of the dentate line on the integrity and the morphology of both sphincters.…”

The usefulness of anorectal manometry in patients with a stoma before and after surgery to restore the continuity of the gastrointestinal tract

“…It has become an important element of the assessment in common social problems -chronic constipation and faecal incontinence, which is highlighted by a number of authors (11, 12, 13). other works are devoted to the assessment of the anal sphincter in patients with intestinal pouch in anastomosis with the anal canal (14,15). They show interesting results of studies that assess the significance of the restoration of anorectal inhibitory reflex RAIR after the surgery of restorative proctocolectomy using DS-IPAA (double-stapled ileal pouch-anal anastomosis).…”