Ileal Pouch Anal Anastomosis with Close Rectal Dissection Using Automated Vessel Sealers for Ulcerative Colitis: A Promising Alternative

Abstract

Background: Despite decennia of experience, ileal pouch anal anastomosis for ulcerative colitis is still associated with high complication rates. The development of automatic vessel sealers has resulted in the revival of a promising surgical alternative to the conventional procedure: close rectal dissection. By preserving the mesorectal layer it is hypothesized that nerve-related and other postoperative complications can be reduced. Methods: All patients with ulcerative colitis with indication for restorative proctocolectomy at our institution during the pilot study underwent the close rectal pouch procedure with temporary diverting ileostomy. Standardized clinical history, anorectal physiology measurements, and endoscopic and histological examination were carried out before and after surgery. Results: The procedure was technically successful in all 10 patients, with a median age of 41 years and a median postoperative follow-up period of 16 months. There were no cases of pelvic sepsis and bladder or sexual dysfunction. The median daytime defecation frequency was 6.0. Endoscopic and histological examination showed no abnormalities. The anorectal physiology supported the good functional results. Conclusion: The preliminary results of the close rectal pouch procedure are promising, with good functional results and a low complication rate after 1 year.

Short-term morbidity and quality of life from a randomized clinical trial of close rectal dissection and total mesorectal excision in ileal pouch–anal anastomosis

“…CRD is an elaborate approach owing to the non-anatomical dissection 4 . Nowadays, the technique has become less elaborate as a result of the use of vessel-sealing devices 5 . In the Academic Medical Centre, Amsterdam, The Netherlands, the TME technique is applied in restorative proctocolectomy, with the exception that the anterolateral mesorectum is preserved, thereby keeping a distance from the nerves.…”

Evaluation of long‐term function, complications, quality of life and health status after restorative proctocolectomy with ileo neo rectal and with ileal pouch anal anastomosis for ulcerative colitis

“…Continued development of RPC in our unit with the introduction of new devices to improve the current technique may improve the results still further. The preliminary results are promising [37].…”

Getting Personal

“…In addition, some authors created their own quality of life questionnaires for their studies. 3,13,45,80,88 …”