LONG-TERM RESULTS OF CONTINENCE FUNCTION IN PATIENTS AFTER ILEOANAL RECONSTRUCTION

An important aim of proctocolectomy with ileal pouch-anal anastomosis (IPAA) is to maintain anal continence. Anal sphincter disruption durin g IPAA is felt to play an important role in loss of continence, which is described in up to 30% of the treated patients in the early postope rative period. Although sphincter function recovers gradually after su rgery, some patients stay incontinent. In our investigation of possibl e parameters involved in preservation of continence after this operati ve procedure, we focused on changes in anal manometry. We compared the se findings with the functional results obtained by questioning the pa tients and physical examination. Anal manometry was performed with a l ow-compliance hydraulic perfusion system. All patients underwent a J-p ouch procedure with a short rectal cuff for ileoanal reconstruction. W e examined 25 patients, 13 underwent operation for the treatment of ul cerative colitis, 12 because of adenomatous polyposis. In the colitis and polyposis group, 28% of the patients reported events of soiling. T hree patients (12%) were incontinent. The remaining 15 patients were c ompletely continent. The median time after operation was 58 months, ra nging from 12 to 96 months. Comparing the results of anal manometry wi th standard values of ten age- and gender-matched healthy volunteers, it was found that there was a significant increase in the threshold of balloon awareness and urge to defecate. These sensations were sometim es elicited by pouch contractions. Median pouch-compliance was also cl early elevated in comparison to rectal compliance (P<0.005). Inhibitor y reflexes during balloon inflation could not be evoked in any of the patients. Comparing continent with incontinent patients there were sig nificant differences in balloon awareness, urge to defecate, and stool frequency (P<0.01, P<0.01 and P<0.001, respectively). But in contrast to other publications, we could not find significant differences in a nal sphincter length, resting and squeezing, anal canal pressure. Pouc h compliance was lowered in incontinent patients and negatively correl ated with stool frequency (P<0.001, r=-0.82). In conclusion, our study indicates that anal sphincter resting pressure alone is not a crucial factor in continence preservation in the long-term after total procto colectomy and IPAA. Poor pouch-compliance and concomitant higher stool frequencies seem to be related to incontinence in this patient group.