SHOULD ILEOANAL POUCH SURGERY BE DENIED TO PATIENTS WITH LOW RESTING PRESSURES

Our aim was to evaluate any impact of preoperative resting pressure up on postoperative physiological results in patients undergoing ileal po uch anal anastomosis. Ninety patients who had undergone manometric stu dy before and I year after surgery were divided irate two groups deter mined by a preoperative mean resting pressure of >50 mm Hg or less tha n or equal to 50 nam Hg. There were significant differences between th ese two groups concerning preoperative maximum resting pressure (P < 0 .001) and length of the high-pressure zone (P < 0.005). However, such; La trend was not seen postoperatively. There were no differences betw een these two groups relative to postoperative mean or maximum resting pressure maximum squeeze pressure, length oi high-pressure zone, sens ory threshold, or capacity. The mean resting pressure decreased after pouch surgery in 82 Her cent of patients with a preoperative mean rest ing pressure of >50 mm Hg. Conversely, 83 per cent of patients with a preoperative mean resting pressure of less than or equal to 50 mm Mg e xperienced an increase in mean resting pressure after pouch surgery. O nly 4 of 23 patients with a preoperative mean resting pressure of less than or equal to 50 nun Kg had decreased postoperative mean resting p ressure, This latter finding has not been previously described, Howeve r, the mean resting pressure of those four patients more than fully re covered within 2 to 3 years after surgery, Although preoperative manom etry may be useful to analyze data and to counsel patients, if should not be used to deny patients surgery. Moreover, this study has reveale d that patients with lower resting pressures do not suffer a deleterio us decrease in resting pressure but actually have improved postoperati ve mean resting pressure.