Clin Colon Rectal Surg 2003; 16(4): 271-276
DOI: 10.1055/s-2004-815620
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Mucosectomy and the Ileoanal Pouch

David E. Beck
  • Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana
Further Information

Publication History

Publication Date:
12 January 2004 (online)

ABSTRACT

Anal canal mucosectomy was originally an essential part of a restorative proctocolectomy. It allowed complete removal of mucosa at risk for inflammation (ulcerative colitis) and for the formation of polyps (polyposis coli). Development of a double-staple technique has led to questions about the necessity of mucosectomy. Several clinical situations (severe rectal dysplasia or carcinoma) argue strongly for a mucosectomy, and technical difficulties with a double-staple technique make it necessary that surgeons performing restorative proctocolectomies have the capability to perform a safe and effective mucosectomy. Mucosectomy techniques as well as the advantages and disadvantages of the technique are described.

REFERENCES

  • 1 Beck D E, Wexner S D. Inflammatory bowel disease: ulcerative colitis and Crohn's disease. In: Beck DE, ed. Handbook of Colorectal Surgery 2nd ed. New York: Marcel-Dekker 2003 0: 259-300
  • 2 Beck D E. Polyps. In: Beck DE. Handbook of Colorectal Surgery. 2nd ed. New York: Marcel-Dekker 2003 0: 429-446
  • 3 Blumberg D, Opelka F G, Hicks T C, Timmcke A E, Beck D E. Restorative proctocolectomy: Ochsner Clinic experience.  South Med J . 2001;  94 467-471
  • 4 Parks A G, Nicholls R J. Proctocolectomy without ileostomy for ulcerative colitis.  BMJ . 1978;  2 85-88
  • 5 Burnstein M J, Schoetz Jr J D, Coller J A, Veidenheimer M C. Technique of mesenteric lengthening in ileal reservoir-anal anastomosis.  Dis Colon Rectum . 1987;  30 863-866
  • 6 Cohen Z, Myers E, Langer B, Taylor B, Railton R H, Jamisson C. Double-stapling technique for low anterior resection.  Dis Colon Rectum . 1983;  26 231-235
  • 7 Lavery I C, Tuckson W B, Easley K A. Internal anal sphincter function after total abdominal colectomy and stapled ileal pouch-anal anastomosis without mucosal proctectomy.  Dis Colon Rectum . 1989;  32 950-953
  • 8 Heald R J, Allen D R. Stapled ileo-anal anastomosis: a technique to avoid mucosal proctocolectomy in the ileal pouch operation.  Br J Surg . 1986;  73 571-572
  • 9 Deen K I, Williams J G, Grant E A, Billingham C, Keighley M R. Randomized trial to determine the optimum level of pouch-anal anastomosis in stapled restorative proctocolectomy.  Dis Colon Rectum . 1995;  38 133-138
  • 10 Curran F T, Sutton T D, Jass J R, Hill G L. Ulcerative colitis in the anal canal of patients undergoing restorative proctocolectomy.  Aust N Z J Surg . 1991;  61 821-824
  • 11 Schmitt S L, Wexner S D, Lucas F V, James K, Nogueras J J, Jagelman D G. Retained mucosa after double-stapled ileal reservoir and ileoanal anastomosis.  Dis Colon Rectum . 1992;  35 1051-1056
  • 12 Lavery I C, Sirimarco M T, Ziv Y, Fazio V W. Anal canal inflammation after ileal pouch-anal anastomosis: the need for treatment.  Dis Colon Rectum . 1995;  38 803-806
  • 13 Heppell J, Weiland L H, Perrault J, Pemberton J H, Telander R L, Beart Jr W R. Fate of the rectal mucosa after rectal mucosectomy and ileoanal anastomosis.  Dis Colon Rectum . 1983;  26 768-771
  • 14 O'Connell P R, Pemberton J H, Weiland L H. et al . Does rectal mucosa regenerate after ileoanal anastomosis?.  Dis Colon Rectum . 1987;  30 1-5
  • 15 Laureti S, Ugolini F, D'Errico A, Rago S, Poggioli G. Adenocarcinoma below ileoanal anastomosis for ulcerative colitis.  Dis Colon Rectum . 2002;  45 418-421
  • 16 Stern H, Walfisch S, Mullen B, McLeod R, Cohen Z. Cancer in an ileoanal reservoir : a new late complication?.  Gut . 1990;  31 473-475
  • 17 Puthu D, Rajan N, Rao R, Rao L, Venugopal P. Carcinoma of the rectal pouch following restorative proctocolectomy. Report of a case.  Dis Colon Rectum . 1992;  35 257-260
  • 18 Rodriguez-Sanjuan J C, Polavieja M G, Naranjo A, Castillo J. Adenocarcinoma in an ileal pouch for ulcerative colitis [letter].  Dis Colon Rectum . 1995;  38 779-780
  • 19 Baratsis S, Hadjidimitriou F, Christodoulou M, Lariou K. Adenocarcinoma in the anal canal after ileal pouch-anal anastomosis for ulcerative colitis using a double-stapling technique. Report of a case.  Dis Colon Rectum . 2002;  45 687-692
  • 20 Sequens R. Cancer in the anal canal (transitional zone) after restorative proctocolectomy with stapled ileal pouch-anal anastomosis.  Int J Colorectal Dis . 1997;  12 254-255
  • 21 Ziv Y, Fazio V W, Sirimarco M T, Lavery I C, Goldblum J R, Petras R F. Incidence, risk factors, and treatment of dysplasia in the anal transitional zone after ileal pouch-anal anastomosis.  Dis Colon Rectum . 1994;  37 1281-1285
  • 22 Tsunoda A, Talbot I C, Nicholls R J. Incidence of dysplasia in the anorectal mucosa in patients with restorative proctocolectomy.  Br J Surg . 1990;  77 506-508
  • 23 Poggioli G, Stocchi L, Cavallari A. Dysplasia and cancer. In: Michelassi F, Milsom JW, eds. Operative Strategies in Inflammatory Bowel Disease New York: Springer-Verlag 1999: 246-255
  • 24 O'Riordain M G, Fazio V W, Lavery I C. et al . Incidence and natural history of dysplasia of the transitional zone after ileal pouch-anal anastomosis: results of a five-year to ten-year follow-up.  Dis Colon Rectum . 2000;  43 1660-1665
  • 25 Ambroze W L, Pemberton J H, Dozois R R, Carpenter H A. Does retaining the anal transitional zone (ATZ) fail to extirpate chronic ulcerative colitis (CUC) after ileal pouch-anal anastomosis (IPAA) [meeting abstract]?.  Dis Colon Rectum . 1991;  34 P20
  • 26 Reissman P, Piccirillo M, Ulrich A, Daniel N, Nogueras J J, Wexner S D. Functional results of the double-stapled ileoanal reservoir.  J Am Coll Surg . 1995;  181 444-450
  • 27 Miller R, Bartolo D C, Orrom W J, Mortensen N J, Roe A M, Cervero F. Improvement of anal sensation with preservation of the anal transition zone after ileoanal anastomosis for ulcerative colitis.  Dis Colon Rectum . 1990;  33 414-418
  • 28 Seow-Choen A T, Tsunoda A, Nicholls R J. Prospective randomized trial comparing anal function after hand-sewn ileoanal anastomosis with mucosectomy versus stapled ileoanal anastomosis without mucosectomy in restorative proctocolectomy.  Br J Surg . 1991;  78 430-434
  • 29 Luukkonen P, Jarvinen H. Stapled vs hand-sutured ileoanal anastomosis in restorative proctocolectomy: a prospective, randomized study.  Arch Surg . 1993;  128 437-440
  • 30 McIntyre P B, Pemberton J H, Beart Jr W R, Devine R M, Nivatvongs S. Double-stapled vs handsewn ileal pouch-anal anastomosis in patients with chronic ulcerative colitis.  Dis Colon Rectum . 1994;  37 430-433
  • 31 Wettergren A, Gyrtrup H J, Grosmann E. et al . Complications after J-pouch ileoanal anastomosis: stapled compared with hand-sewn anastomosis.  Eur J Surg . 1993;  159 121-124
  • 32 Liljeqvist L, Lindquist K, Ljungdahl I. Alterations in ileoanal pouch technique, 1980 to 1987; complications and functional outcome.  Dis Colon Rectum . 1988;  31 929-938
  • 33 Delaurier G A, Nelson H. Ileal pouch-anal anastomosis. In: Hicks TC, Beck DE, Opelka FG, Timmcke AE, eds. Complications of Colon and Rectal Surgery Baltimore: Williams & Wilkins 1996: 339-356
  • 34 Roberts P L. Operative techniques for ileoanal pouches.  Clin Colon Rectal Surg . 2001;  14 42-47
    >