Totally stapled abdominal restorative proctocolectomy

Abstract

A technique of totally stapled abdominal restorative proctocolectomy is reported in 20 consecutive patients using a 20 x 20 cm J pouch and a stapled ileoanal anastomosis. The stapled ileoanal anastomosis had to be abandoned in three patients because of attempted mucosectomy in one and megarectum in two. One patient receiving steroids had a covering ileostomy. The remaining 16 patients had a totally stapled procedure without a covering ileostomy. Three patients developed serious postoperative morbidity but they were the only patients receiving steroids at the time of the operation. Of the remaining 13 patients none developed serious complications, the median hospital stay was 14 days and the median operating time was 150 min. The operation may be a technical advance particularly in allowing pouch construction without ileostomy in fit patients who are not receiving steroids at the time of operation.

Reconstructive Surgery for Failed Ileal Pouch-Anal Anastomosis

“…1 Technical innovations during the past 20 years, such as the J-pouch configuration 9 and the stapled IAA, 10,11 have decreased the short-term morbidity and have allowed the procedure to be performed by a greater number of surgeons. Although postoperative morbidity decreases with increasing surgical experience, 2, 3, 7, 12, 13 long-term failure rates between 0.8 and 9 percent 2-7, 12 have been reported.…”

Randomized Prospective Trial Comparing Ileal Pouch-Anal Anastomosis Performed by Excising the Anal Mucosa to Ileal Pouch-Anal Anastomosis Performed by Preserving the Anal Mucosa

“…Moreover, our standard operative approach-that is, endorectal mucosa resection and handsewn ileal pouch-anal anastomosis (IPAA)-has been found to be most applicable to patients who are young and thin. 23 Principally because up to 50% of patients after endorectal mucosa resection and handsewn IPAA are incontinent of stools at night, a new operation was introduced: double-stapled ileal pouch-anal anastomoSiS. 4 In this operation, the ileal pouch is stapled to the top of the anal canal, thus preserving the anal transition zone (ATZ).…”

Portal Vein Thrombi After Ileal Pouch-Anal Anastomosis: Its Incidence and Association with Pouchitis

“…Over the past 20 years technical innovations such as the Jpouch confi guration 2 and the stapled ileo-anal anastomosis, [3][4][5] together with surgical experience, 6 have decreased short-term morbidity; however, long-term complications, particularly small bowel obstruction 7 and pouchitis, [8][9][10][11][12] continue to be a problem.…”