Abstract

ABSTRACT:

Purpose: To investigate the role of completion mucosectomy for patients suffering from intractable diarrhea, tenesmus and pain after a stapled ileal pouch anal anastomosis (IPAA) procedure. A small percentage of patients develop disabling bowel symptoms after the IPAA procedure and are diagnosed with pouchitis. We hypothesized that a number of these patients may have ulcerative colitis in the residual rectal mucosa that may be responsible for these symptoms.

Methods: Sixteen (16) patients who underwent double-stapled IPAA and had symptoms of intractable pouchitis underwent subsequent residual rectal mucosectomy with pouch advancement. Data were collected from medical records and telephone interviews with the patient. Follow-up was incomplete on two patients who were then excluded from data analysis.

Results: Fourteen patients (10M, 4F) ranging from 19-55 years in age (mean=38) were included in the analysis. Mean follow-up was 17 months (range= 2-29, median=19). Prior to mucosectomy, 100%, 38% and 23% of patients had been treated with antibiotics, bismuth, and probiotics, respectively. 71% of patients reported improvement in their symptoms after mucosectomy. There were significant decreases in both the number of bowel movements during the day (14.4(9.3) to 7.9(4.3), p<0.01) and night (5.7(3.2) to 2.8(2.2), p<0.01). Following mucosectomy there was significant improvement in stool quality (p=0.02) and a decrease in the number of patients experiencing bloody stools (64% to 29%, p=0.07). These results were more marked in patients whose rectal cuff has histopathologic evidence of inflammatory bowel disease. Anal stricture occurred in 43% of patients post-operatively, and all of these were successfully managed with dilations in the office setting.

Conclusion: Chronic ulcerative colitis of the native rectal mucosal remnant is an important consideration in those patients who present with symptoms compatible with intractable pouchitis after a double-stapled IPAA. Mucosectomy provides relief in the majority of such patients and is an important addition to the surgeon’s armamentarium in the management of these debilitating symptoms.

Recommended Citation

Glenn Ault, Andreas Kaiser, Petar Vukasin, and Robert Beart Dr. (2008) "Mucosectomy as Treatment for Intractable Pouchitis Symptoms Following Ileal Pouch Anal Anastomosis," World Journal of Colorectal Surgery: Vol. 1 : Iss. 1, Article 1.
Available at: http://services.bepress.com/wjcs/vol1/iss1/art1