ILEAL POUCH-ANAL ANASTOMOSIS FAR ULCERATIVE-COLITIS AND FAMILIAL ADENOMATOUS POLYPOSIS - IS ENDOANAL MUCOSECTOMY MANDATORY

The aim of this study was to assess the clinical outcome after ileal p ouch-anal anastomosis with mucosectomy for ulcerative colitis and for familial adenomatous polyposis, and to characterize the histology of t he stripped endoanal mucosa with particular reference to the ulcerativ e colitis activity, adenomatous polyps and dysplasia. Twenty-eight pat ients were operated, 16 for ulcerative colitis (group I) and 12 for fa milial adenomatous polyposis (group II). In group I, there were no int raoperative complications, but mucosectomy was tedious in 10 patients (62 %) and the anastomosis was performed under some degree of tension in 10 patients (62 %). In group II, there was a direct injury of the i nternal sphincter by a posterior tear during the mucosal stripping in one case. Mucosectomy was easy to perform in 8 patients (67 %) and 10 anastomoses (84 %) were performed under tension. In both groups, there were no postoperative complications related to the mucosectomy or to the anastomosis itself. Functional results were good, with a normal co ntinence in 80 % of ulcerative colitis patients and 92 % of familial a denomatous polyposis patients. Review of histological sections of the stripped anal mucosa in group I showed chronic active ulcerative colit is in 8 patients (50 %), chronic non-active ulcerative colitis in 4 (2 5 %) and quiescent ulcerative colitis in 4 (25 %). There was only one case of moderate dysplasia in a patient with a Dukes A carcinoma. In g roup II, anal mucosa showed micropolyps in all cases with mild dysplas ia in 3 cases (25 %) and moderate dysplasia in 9 (75 %). In conclusion , a careful mucosectomy does not affect the surgical outcome and the f unctional results of ileal pouchanal anastomosis. Since removal of the disease is more complete, the anal mucosa should always be removed do wn to the level of the dentate line in restorative proctocolectomy for ulcerative colitis and for familial adenomatous polyposis.