EVOLUTIVE STUDY OF THE FUNCTIONAL RESULTS AFTER RESTORATIVE PROCTOCOLECTOMY FOR ULCERATIVE-COLITIS

Aim: evolutive study of the functional results after restorative proct ocolectomy for ulcerative colitis. Patients and methods: prospective s tudy in 24 patients with an ileoanal ''J'' pouch (n = 8: mucosectomy a nd hand-sewn anastomosis; n 16: stapled anastomosis without mucosectom y). A clinical survey was carried out during two evolutive follow-ups of the functional pouch (medians: 14.5 and 39.0 months) as well as an anorectal manometry study during the preoperative period and in two fo llow-ups after the creation of the pouch (medians: 6.0 and 35.5 months ). Results: the mean frequency of defecation per 24 hours and per nigh t teas significantly reduced in the first follow-up (5.5 [24 h]; p < 0 .003 and 1.0 [per night]; p < 0.009) compared with the postoperative p eriod (7.9 [24 h] and 1.4 [per night]), with no significant changes in the second follow-up (5.5 [24 h] and 0.9 [per night]), At the same ti me, it has been significantly lower in patients with stapled anastomos is in the different evolutive follow-ups, One patient (4.2%) had major fecal incontinence in the two evolutive follow-ups and 7 (29.2%) and 6 (25%) patients had minor incontinence in the first and second follow -up respectively, The mean maximum resting anal pressure in the first follow-up was significantly lower (p = 0.002) in patients with mucosec tomy than the values observed in patients with stapled anastomosis (35 .4 vs 68.0 mmHg). In the second follow-up increased significantly (p = 0.046) only in patients with mucosectomy (55.1 mmHg). Recto-anal inhi bitory reflex was present in 2 (10%) and 9 (45%) patients in the first and second follow-up respectively. Conclusions: the functional result s improve significantly with the follow-up time, fundamentally during the first year of the functional pouch.