PRESERVATION OF COMPLETE ANAL SPHINCTERIC PROPRIOCEPTION IN RESTORATIVE PROCTOCOLECTOMY - THE INHIBITORY REFLEX AND FINE CONTROL OF CONTINENCE NEED NOT BE IMPAIRED

This study evaluates whether reflex function of the anal sphincter rem ains unchanged after restorative proctocolectomy, provided that the sp hincter remaining is kept intact, without mucosal stripping or endo-an al anastomosis. Paired tests of anorectal function were performed befo re, and a median of 6 (range 2-12) months after restorative proctocole ctomy with stapled, end to end pouch-anal anastomosis. Beforehand, dis tension of the rectum with 50 mi of air produced a median (interquarti le range) increase in pressure within the rectum of 22 (15-29) cm H2O and reflex inhibition of the anal sphincter from a pressure of 76 (62- 106) cm H2O to a pressure of 34 (15-52) cm H2O. After the procedure, d istension of the ileal pouch with 50 mi of air produced an increase in pressure within the pouch of only 5 (4-8) cm H2O (p<0.001 compared wi th beforehand) and reflex inhibition of the anal sphincter from a pres sure of 62 (25-79) cm H2O to 37 (17-68) cm H2O. Maximal reflex inhibit ion of the upper third of the anal sphincter to a pressure of 26 (15-4 8) cm H2O was observed when pressure within the pouch increased by 16 (11-22) cm H2O. After restorative proctocolectomy, all patients were c ontinent (two experienced minor nocturnal leakage of mucus) and 25 cou ld discriminate between flatus and faeces. Thus, reflux function was p reserved in response to changes in pressure, ensuring that the subtler aspects of anal continence were preserved.