Functional outcomes in patients with mucosal ulcerative colitis after ileal pouch-anal anastomosis by the double stapling technique - Is there a relation to tissue type?

PURPOSE: The aim of this study was to evaluate any differences in functiona l outcome in patients with mucosal ulcerative colitis after restorative pro ctocolectomy and ileal pouch-anal anastomosis with use of the double stapli ng technique relative to the type of tissue in the stapled doughnut. METHOD S: Between September 1988 and June 1997, the pathology of all patients with mucosal ulcerative colitis who underwent ileal pouch-anal anastomosis with use of the double stapling technique were reviewed. Information was obtain ed regarding the tissue types in the distal tissue rings (doughnuts) obtain ed from the stapled ileal pouch-anal anastomosis. The level of anastomosis was classified according to the type of tissue in the distal doughnut: Grou p I-patients in whom the anal transitional zone was removed and the distal doughnut included squamous epithelium or transitional epithelium and Group II-patients in whom the anal transitional zone was preserved because the di stal doughnut revealed only columnar epithelium. Functional outcomes were a ssessed and compared by detailed questionnaires mailed to all patients at l east one year after ileal pouch-anal anastomosis surgery. RESULTS: Distal d oughnuts were obtained from the stapled ileal pouch-anal anastomosis in 222 patients with mucosal ulcerative colitis. Follow-up data at a mean of 38 ( range, 12-132) months were obtained in 138 (62.2 percent) patients, includi ng 72 males, with a mean age of 46.9 (range, 13-79) years. Group I consiste d of 40 patients (29 percent; 35 (25.4 percent) who had squamous epithelium and 5 (3.6 percent) who had transitional epithelium in the distal tissue r ings). Group II consisted of 98 patients (71 percent) with columnar epithel ium in the distal tissue rings. Age at diagnosis and operation, duration of disease, length of follow-up, and stage of pouch surgery were similar in t he two groups. Incontinence scores, frequency of bowel movement, use of a p rotective pad, discrimination between gas and stool, use of antidiarrheals, life-style alteration, and patient satisfaction showed similar functional results between the two groups. CONCLUSIONS: The tissue type in the stapler distal doughnut did not greatly influence functional outcome. Failure to i dentify a relationship may attest to the variable height and composition of the anal transitional zone.