RISK OF RESIDUAL RECTAL MUCOSA AFTER PROCTOCOLECTOMY AND ILEAL POUCH-ANAL RECONSTRUCTION WITH THE DOUBLE-STAPLING TECHNIQUE - POSTOPERATIVEENDOSCOPIC FOLLOW-UP-STUDY

PURPOSE: This study was designed to assess the risk of retained rectal mucosa after proctocolectomy and ileal pouch-anal anastomosis with th e double-stapling technique. METHODS: A total of 113 patients underwen t proctocolectomy with an ileal pouch-anal reconstruction. In 57 patie nts the anastomosis between pouch and proximal anal canal was performe d using the double-stapling technique. In 26 patients the procedure wa s carried out without a protecting ileostomy. Of the remaining 31 pati ents with a proximal ileostomy, 15 underwent endoscopy six weeks posto peratively. Circular biopsies were taken just distal from the pouch-an al anastomosis. RESULTS: Histologic examination revealed rectal mucosa in at least one biopsy in 7 of 15 patients. At follow-up (mean 18 mon ths) no (distal) pouchitis was clinically noticed. In one patient with familial pouchitis, a few polyps, distal of the anastomosis, had to b e endoscopically removed. CONCLUSIONS. Double-stapled ileal pouch-anal anastomosis has a considerable risk of residual rectal mucosa, becaus e of combined linear transection and circular stapling with bilateral dog-ear formation of rectal mucosa. Residual rectal mucosa did not see m to influence clinical results at follow-up.