FUNCTIONAL RESULTS OF THE DOUBLE-STAPLED ILEOANAL RESERVOIR

BACKGROUND: The preferred method for creation of an ileoanal reservoir is still controversial. We prospectively studied the functional and p hysiologic outcome of our patients who underwent a double-stapled ileo anal reservoir (DSIAR). STUDY DESIGN: All consecutive patients who und erwent restorative proctocolectomy with a DSIAR between 1988 and 1993 were evaluated. Functional results were assessed by questionnaires and anal manometry preoperatively and two, 12, and 24 months postoperativ ely. RESULTS: One hundred forty patients (90 males and 50 females) wit h a mean age of 40.7 (range, 12 to 71) years were evaluated. Of these, 107 patients (77 percent) had ulcerative colitis, 21 (15 percent) had familial adenomatous polyposis, six (4 percent) had indeterminate col itis, and six (4 percent) had a postoperative diagnosis of Crohn's dis ease. One hundred twenty-four (95 percent) of the 131 patients with cl osed stomas were available for functional and manometric evaluation at a mean follow-up period of 24 months. A 32 percent decline in the mea n resting pressure (from 71.3+/-4 to 48.2+/-3.4 mm Hg) occurred early after DSIAR (p<0.001) with partial recovery by 24 months. The maximal internal sphincter resting pressure showed a 39 percent decline (from 90.8+/-4.9 to 55.3+/-5.7 mm Hg, p<0.005) with recovery after 12 months . There were no significant changes in the length of the high-pressure zone or mean or maximal squeeze pressures. A mean of 5.4 (two to 13) bowel movements occurred during the day and a mean of 1.2 (zero to fou r) occurred at night. Perfect or almost perfect continence was reporte d during the day and night, respectively, by 95 and 92 percent of the patients. Overall perioperative complications occurred in 30 patients (21 percent) including septic complications in eight (6 percent), and pouchitis in eight (6 percent). There was one postoperative death (0.7 percent). CONCLUSIONS: Double-stapled ileoanal reservoir is associate d with good subjective functional and objective physiologic results an d has acceptable rates of morbidity and mortality.