PELVIC POUCH-ANAL ANASTOMOSES - PROS AND CONS ABOUT OMISSION OF MUCOSECTOMY AND LOOP ILEOSTOMY - A STUDY OF 60 PATIENTS

Pelvic pouches were constructed in 60 consecutive patients from 1987 t o 1991. The first 30 patients underwent mucosectomy and construction o f handsewn reservoirs, and ileoanal anastomoses protected by loop ileo stomy (group A). In the following 12 patients (group B1) J pouches and ileoanal anastomoses were constructed by total stapling technique wit hout mucosectomy, with a loop ileostomy. In the last 18 patients the l oop ileostomy was omitted (group B2). A comparison between group A and B and between group B1 and B2 was made concerning anaesthesia time, h ospital stay, blood transfusions, postoperative complications and pouc h function at 2 and 12 months. It was found that the stapling techniqu e (group B) reduced anaesthesia time considerably and reduced the; nee d of blood transfusions. Postoperatively thromboembolic episodes and s igns of adrenal insufficiency were seen only in the handsewn group, wh ile postoperative febrile conditions were more common in the stapled g roups. Ileo-anal dehiscence occurred in two patients without loop ileo stomy. Treatment by establishment of a loop ileostomy, local irrigatio n and administration of antibiotics were successful, the anastomoses h ealed within 2 weeks and there was no further complications before or after loop closure. Omitting the loope ileostomy saved the patient a f urther operation and reduces hospital stay and sick leave. After two m onths of pouch function, patients with handsewn pouches had a lower nu mber of bowel movements (5.5/24 h and 0.8 during the night) than patie nts with stapled pouches (8.0/24 h and 1.9 during the night). At 12 mo nths, however, the difference between the groups of patients had dimin ished. The mean evacuation rate was 5.0/0.5 for patients with handsewn and 5.6/0.6 for those with stapled pouches. The continence rate was s ignificantly better in patients with stapled anastomoses than in those with handsewn anastomoses. However, pouch endoscopy revealed rings of remaining rectal mucosa in more than half of the patients with staple d anastomoses.