ILEAL POUCH-ANAL ANASTOMOSIS - IS PREOPERATIVE ANAL MANOMETRY PREDICTIVE OF POSTOPERATIVE FUNCTIONAL OUTCOME

PURPOSE: The aim of this study was to determine the value of preoperat ive anal manometry in predicting postoperative continence. METHODS: An al manometry was performed in 73 consecutive patients before ileal pou chanal anastomosis (IPAA) surgery (ml), before loop ileostomy closure (m2), and at a follow-up of one (m3) and two (m4) years. Mean and maxi mum resting and squeezing pressures were documented at each occasion. One year after surgery, pressures were correlated (r) with an incontin ence score. RESULTS: A significant (P < 0.05) decrease in mean resting pressures was observed after IPAA (ml = 66 mmHg; m2 = 42.8 mmHg), fol lowed by a significant (P < 0.05) improvement of mean resting pressure after loop ileostomy closure (m3 = 53.8 mmHg; m4 = 54.7 mmHg). Mean s queezing pressures did not change (P > 0.05) at any time during the st udy (ml = 114 mmHg; m2 = 102.9 mmHg; m3 = 103.4 mmHg; m4 = 95.8 mmHg). There was no correlation between preoperative mean resting pressure a nd postoperative (ml) incontinence score. CONCLUSION: Anal manometry s howed a characteristic trend in internal anal sphincter injury after I PAA followed by recovery after ileostomy closure. However, it failed t o prove helpful in the prediction of clinical outcome. Thus, although this study supports the continued use of manometry in a research setti ng, it challenges the value of routine manometry in a clinical context .