Ileoneorectal anastomosis - Early clinical results of a restorative procedure for ulcerative colitis and familial adenomatous polyposis without formation of an ileoanal pouch

Objective To evaluate a new surgical procedure, ileoneorectal anastomosis ( INRA), in patients with ulcerative colitis (UC) and familial adenomatous po lyposis (FAP). Summary Background Data Surgical treatment in UC and FAP aims to resect dis eased colonic mucosa and restore oroanal continuity. The ileopouch anal ana stomosis achieves this but has a 15% to 35% complication rate, a 10% failur e rate, and an unpredictable functional outcome. An alternative surgical te chnique, INRA, has been developed in which the rectal mucosa is replaced by a vascularized ileal mucosa graft. Methods Eleven patients underwent an INRA procedure with a temporary divert ing ileostomy. Clinical history, repeat endoscopy, histologic examination, and rectal compliance measurements were carried out before and after surger y. Results The INRA procedure was technically successful in ail patients. Endo scopy showed ingrowth of ileal mucosa in the neorectum, with 100% coverage after 6 weeks. No patient had pelvic sepsis, neorectal-anal or -vaginal fis tula, autonomic nerve damage, or fecal incontinence. Neorectal function imp roved with time. The median 24-hour defecation frequency decreased from 15 (range 9 to 25) to 7 (range 4 to 10) at II months follow-up, and the median maximum tolerated volume increased to 157 (range 130 to 225) mi. Anal mano metry and electrosensitivity were not affected by the surgery. Histologic b iopsy samples after I year showed a normal small intestinal mucous membrane , without inflammation or fibrosis. Conclusion The combination of a tow complication rate and good neorectal fu nction at 1 year is a substantial improvement that justifies extension of t he clinical application in patients with UC and FAP.