Handsewn ileal pouch-anal anastomosis on the dentate line after total proctectomy - Technique to avoid incomplete mucosectomy and the need for long-term follow-up of the anal transition zone

PURPOSE: During ileal pouch-anal anastomosis, both conservation of the anal transitional zone during the stapled technique and incomplete mucosectomy in the standard Park's procedure may expose the patient to disease recurren ce. We propose here an technique whose aim is to solve both problems by per forming handsewn ileal pouch-anal anastomosis on the dentate line after rec tal eversion and total proctectomy. METHODS: We reviewed the records of 172 consecutive patients who had undergone ileal pouch-anal anastomosis since 1984 for chronic ulcerative colitis (n = 80), familial adenomatous polyposi s (n = 48), selected cases of Crohn's disease (n = 42), or other causes (n = 2). RESULTS: One patient (0.5 percent) died postoperatively. Operative mo rbidity was similar to that reported after the Park's and stapled procedure s. Of our 128 patients with a five-year follow-up, anastomotic stricture oc curred in 15 (12 percent), and 4 patients (3 percent) had to have pouch rem oval. Stool frequency per 24 hours was 4.8 +/- 1.6 (range, 1-11), continenc e was perfect in 104 patients (81 percent), and sexual activity was estimat ed to be unchanged in 120 (94 percent). No evidence of disease recurrence w as noted in the patients with familial adenomatous polyposis or ulcerative colitis. CONCLUSIONS: During ileal pouch-anal anastomosis, Park's procedure carries the risk of incomplete mucosectomy and disease recurrence, and the stapled procedure requires a long-term follow-up of the anal transitional zone. Our alternative technique with total proctectomy avoids both problems and gives similar long-term functional results.