STATE OF THE DEFUNCTIONALIZED SPHINCTER IN PATIENTS UNDERGOING ILEOANAL POUCH ANASTOMOSIS

PURPOSE: Our aim was to determine manometric status and functional out come of the ileoanal pouch procedure in a subset of patients with defu nctionalized anal sphincters as a result of long-term fecal diversion. METHODS: The anal manometric profiles of 12 patients defunctionalized for one year or more were compared with 26 patients with nondefunctio nalized anal sphincters. Functional data were obtained from the Lahey Clinic Ileoanal Pouch Registry. RESULTS: Preoperative manometric data revealed a mean resting pressure of 91.5 mmHg in the nondefunctionaliz ed group vs. 68.7 mmHg in the defunctionalized group; mean squeezing p ressure was 171.7 mmHg (nondefunctionalized group) vs. 102.3 mmHg (def unctionalized group); and squeezing pressure volume was 1,283,000 mmHg (3) (nondefunctionalized group) vs. 585,000 mmHg(3) (defunctionalized group). Functionally both groups had a mean of 6.1 bowel movements in a 24-hour period and could defer defecation for a mean of 2 hours. Lea kage occurred in 22 percent of the defunctionalized group and 17 perce nt of the nondefunctionalized group (P = 0.35). CONCLUSION: Despite ph ysiologic perturbations, the long-term, defunctionalized anal sphincte r can adequately support a restorative procedure without regard to tim ing of pouch creation.