INTERNAL ANAL-SPHINCTER ACTIVITY AFTER RESTORATIVE PROCTOCOLECTOMY FOR ULCERATIVE-COLITIS - A STUDY USING CONTINUOUS AMBULATORY MANOMETRY

PURPOSE: The aim of this study was to further investigate continuous a mbulatory anal manometry which has recently been introduced as a metho d for studying anorectal activity in ambulant patients, thereby avoidi ng many of the potential drawbacks of static techniques. METHOD: In th is study continuous ambulatory manometry was used to assess the activi ty of the internal anal sphincter in patients who had undergone restor ative proctocolectomy, and, in particular, to compare patients who had undergone conventional mucosal proctectomy with sutured endoanal, ile oanal anastomosis with patients who had undergone restorative proctoco lectomy with preservation of the entire anal canal by means of stapled , end-to-end, ileoanal anastomosis without mucosectomy. RESULTS: Evide nce of basal internal sphincter activity was found in only 38 percent of patients after mucosal proctectomy with sutured endoanal anastomosi s, whereas all patients after restorative proctocolectomy with stapled end-to-end anastomosis and all control individuals showed such activi ty of the internal sphincter. Similarly, the number of sampling episod es seen in patients after mucosal proctectomy with endoanal anastomosi s was significantly less (median, 0.0/hours (0-30/hours)) than the num ber of sampling episodes observed in patients after end-to-end anastom osis (median, 4.5/hours (1-48/hours)) or in control individuals (media n, 5.6/hours (0-31/hours)) (P < 0.001). CONCLUSIONS: These results sug gest that the internal anal sphincter is damaged in the course of muco sal proctectomy and endoanal anastomosis. In contrast, after restorati ve proctocolectomy with stapled, end-to-end anastomosis normal functio n of the internal sphincter is preserved.