Completion Mucosectomy for Retained Rectal Mucosa Following Restorative Proctocolectomy with Double-stapled Ileal Pouch-anal Anastomosis

Introduction: Colectomy with ileal pouch-anal anastomosis has become widely accepted and is now considered the procedure of choice for patients with ulcerative colitis (UC) as well as familial adenomatous polyposis (FAP).

Discussion: The clear patient advantage of functional continence has pushed this procedure to the forefront in treating both UC and FAP. As a result, the procedure continues to evolve with recent debate centering on the question of whether to perform a double-stapled technique without rectal mucosectomy or a handsewn anastomosis following transanal mucosectomy. Although continence and complication rates continue to be hotly debated, it is understood that performing the stapled procedure does leave a rectal cuff, which carries with it the possibility of disease persistence or recurrence. As such, if the rectal cuff becomes symptomatic or dysplastic, it must be removed. This is accomplished by performing a transanal completion mucosectomy and reconstructing the ileal pouch-anal anastomosis.