CLINICAL AND PHYSIOLOGICAL EVALUATION OF ANORECTAL EVERSION DURING RESTORATIVE PROCTOCOLECTOMY

Fifty patients had a restorative proctocolectomy with stapled end-to-e nd ileoanal anastomosis by the eversion technique. Median (interquarti le range) maximum resting anal pressure was 90 (73-116) cmH(2)O before restorative proctocolectomy and 71 (51-88)cmH(2)O 1 year after surger y (P<0.001). Median maximum squeeze pressure was 141 (110-185)cmH(2)O before surgery and 146 (118-186) cmH(2)O 1 year after surgery (P not s ignificant). Median thresholds for sensation in the lower third of the anal canal before and 1 year after surgery were 5.3 and 7.1 mA, respe ctively (P=0.006). One year after restorative proctocolectomy, all pat ients were continent, although two experienced leakage of mucus requir ing a pad. Forty-two patients (84 per cent) could discriminate between faeces and flatus. Eversion of the anorectum during restorative proct ocolectomy impairs the motor and sensory functions of the anal sphinct er. Most patients achieved satisfactory anal continence, however, desp ite these physiological changes.