Assessment of Anorectal Funciton after Restorative Proctocolectomy with Ileoanal Anastomosis for Ulcerative Colitis and Polyposis Coli

Yoshio Takesue, Takashi Yokoyama*, Takashi Kodama, Katsunari Miyamoto, Yoshiaki Murakami, Yuichiro Matsuura

First Department of Surgery, Hiroshima University School of Medicine
*Department of General Medicine, Hiroshima University Hospital

Eighteen patients (12 with ulcerative colitis and 6 with polyposis coli) who underwent colectomy, mucosal proctectomy, and ileo-anal anastomosis were examined to assess postoperative neorecto-anal function by serial ano-rectal sphincter measurement. Values were recorded before a pullthrough operation, just before ileostomy closure, and 1 month and 3 months or more after ileostomy closure. The mean number of bowel movements was 4.7 per day after ileostomy closure in patients with a J-pouch construction, and there was a significant difference as compaired with patients without a pouch construction (straight ileoanal anastomosis) (10.0 per day). Though the ano-rectal resting pressure and maximal squeeze pressure decreased just before ileostomy closure, these values increased considerably and achieved levels close to those for normal control subjects soon after ileostomy closure. The sensitivity threshold volume (STV) and the maximal tolerance volume (MTV) were measured to assess the reservoir function of the terminal ileum. There was no significant difference in STV and MTV between without a pouch construction and those with a J-pouch construction, whearas the number of bowel movements of the former was twice as many as the latter. Therefore we considered that ileal reservoir of the J-pouch not only provides an area for fecal storage but also reduces peristalsis in the distal ileum by side-to-side anastomosis of the antiperistaltic and iso-peristaltic intestine.

Key words
ulcerative colitis, familial polyposis coli, ileoanal anastomosis, anorectal function, continence

Reprint requests
Yoshio Takesue First Department of Surgery, Hiroshima University School of Medicine
1-2-3 Kasumi, Minami-ku, Hiroshima, 734 JAPAN

Accepted
December 12, 1990

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