Ileal Pouch Anal Function After Endoanal Mucosectomy and Handsewn Ileoanal Anastomosis Compared with Stapled Anastomosis Without Mucosectomy

Objective: To compare manovolumetric results and functional outcome after restorative proctocolectomy with either mucosal proctectomy and handsewn pouch-anal anastomosis or stapling.

Design: Prospective randomised study.

Setting: University hospital, Sweden.

Subjects: 80 Consecutive patients undergoing restorative proctocolectomy.

Interventions: 37 patients were randomised to have mucosectomy and a handsewn anastomosis and 43 patients to have a stapled anastomosis.

Main Outcome Measures: Comparisons of anal sphincter function and clinical outcome in terms of continence and overall functional score between the two groups of patients.

Results: There was persistent reduction in anal resting tone at one year amounting to 29% in the handsewn group and and to 21% in the stapled group (p < 0.001 compared with preoperative in both groups). Daytime continence was similar, but patients with stapled anastomoses experienced less soiling during sleep, especially in the early postoperative period (5/43, 12% compared with 15/33, 45% at one month, p < 0.001). The arbitrary overall functional score was, however, similar in both groups.

Conclusion: Handsewn and stapled ileal pouch-anal anastomoses result in similar postoperative anal sphincter impairment and overall clinical outcome.