ANORECTAL MANOMETRY AND ILEONAL ANASTOMOS IS - PREOPERATIVE AND POSTOPERATIVE MANOMETRIC COMPARISON

The aim of this study was to evaluate the physiological and manometric changes of anorectal function after proctocolectomy and ileal J pouch anastomosis performed in 13 patients. A short muscular rectal cuff wa s conserved in the first 5 patients, mucosectomy was performed in the next patients (Group M), and the entire rectum and proximal portion of the anal canal (1 mm aghove the dentate line) were resected without m ucosectomy (Groupe WM) in the most recent patients. With a median post operative follow-up of 18 months, anorectal continence was perfect in 9 patients, and minimal incontinence were observed in 4 patients (2 pa tients in Group M, and 2 patients in Group SM). In Group M, the restin g lower anal canal pressure was significantly decreased after the oper ation and was less than the postoperative resting lower anal canal pre ssure observed in Groupe SM. The resting upper anal canal pressure in continent patients was inferior to the postoperative values measured i n patients with minimal incontinence. In all the groups, no change in squeeze pressure was observed after the operation. During the postoper ative period, the rectoanal inhibitory reflex was absence in all patie nts. The volume necessary for sensation threshold was increased after the operation, in the same number of patients in Group M and SM, and m ore frequently in continent patients compared with patients with soili ng. The absence of muscular rectal cuff and mucosectomy seems to provi de best results than rectal cuff preservation. After the operation, a marked decrease in the resting pressure and an increase in the volume necessary to onset of threshold sensation, were associated with the pr esence of minimal incontinence.