STAPLED ILEAL POUCH-ANAL ANASTOMOSIS WITH RESECTION OF THE ANAL TRANSITION ZONE

We assessed the outcome of stapled ileal J-pouch-anal anastomosis with intersphincteric resection of the anal transition zone in 83 consecut ive patients with ulcerative colitis (a = 71) or familial adenomatous polyposis (n = 12). There was no postoperative mortality. Two patients (2.4%) required permanent ileostomy for manifestation of unsuspected Crohn's disease. Major postoperative complications consisted of pelvic sepsis, anastomotic leakage, and pancreatitis with 3.6% each. Both, f requency of bowel movements and degree of continence improved with tim e. Two years after takedown of the diverting ileostomy 45 patients wit h ulcerative colitis and 12 with familial adenomatous polyposis were a ssessed with a frequency of bowel movements of 5.6 +/- 2 and 3.2 +/- 1 per 24 h, respectively (P < 0.05). At this time none of them had majo r daytime or nighttime incontinence. Minor incontinence was reported b y 9% and 14% of the patients with ulcerative colitis during day-time a nd night-time, respectively. The patients with familial adenomatous po lyposis demonstrated better results, without day-time seepage and inte rmittent nocturnal seepage in only 9%. It is concluded that direct ile al J-pouch-anal anastomosis is a safe procedure with excellent functio nal results for patients with ulcerative colitis and familial adenomat ous polyposis.