DOUBLE-STAPLED VS HANDSEWN ILEAL POUCH-ANAL ANASTOMOSIS IN PATIENTS WITH CHRONIC ULCERATIVE-COLITIS

Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the treatm ent of choice for most patients with chronic ulcerative colitis. Wheth er or not a double-stapled technique, which should preserve the anal t ransition zone and avoid prolonged anal dilation, facilitates superior fecal continence compared with conventional mucosal resection and han dsewn anastomosis is unknown. PURPOSE: The aim of this study was to co mpare functional results after double-stapled and handsewn IPAA. METHO DS: Twenty-seven consecutive patients (13 females, 14 males; mean age, 37 years) who had proctocolectomy and double-stapled IPAA a) for chro nic ulcerative colitis were identified. Each was matched by sex, age, and surgeon to a control who had undergone a conventional handsewn ana stomosis. Functional results at six months after ileostomy closure wer e compared. RESULTS: Median stool frequency in each group was seven. T he prevalence of pouchitis was 22 percent in both groups. One pouch fa ilure occurred in each group. The percentage of patients from the doub le-stapled group with daytime spotting was similar to that of the hand sewn group (18 percent vs. 26 percent, P > 0.5). Nighttime soiling rat es were similar as well (41 percent vs. 48 percent, P > 0.5). CONCLUSI ONS: Double-stapled IPAA appears to convey no early functional advanta ge over handsewn IPAA for chronic ulcerative colitis.