ULCERATIVE-COLITIS - FUNCTIONAL RESULTS AFTER ILEAL POUCH-ANAL ANASTOMOSIS

Stool frequency after ileal pouch-anal anastomosis (IPAA) is about 5/d ay after adaptation during the first year. It depends on stool volume and pouch capacity, not on the design of the pouch. In most cases evac uation is spontaneous and as complete as in healthy rectum. 67% of pat ients are perfectly continent, while 19% have to wear pads due to inte rmittent leakage. Complete incontinence is reported in 0-4 % of the pa tients. Preservation of the anal transitional zone by the double-stapl ing technique does not improve functional results when compared to end oanal mucosectomy or intersphincteric resection. Impairment of contine nce is caused by damage of the internal sphincter with consecutive dec rease of the pouch-anal pressure gradient. Despite altered reflex acti vity, stool discrimination is preserved in most patients. The loss of colonic water and electrolyte absorption is compensated by decreased r enal excretion. Alterations in bile acid metabolism are lower after IP AA than after ileostomy. Bacterial overgrowth may lead to deterioratio n of the functional results.