TY - JOUR
T1 - The effect of neo-rectal wall properties on functional outcome after colonic J-pouch-anal anastomosis
AU - Gosselink, Martijn P.
AU - Zimmerman, David D.
AU - West, Rachel L.
AU - Hop, Wim C.
AU - Kuipers, Ernst J.
AU - Schouten, W. Rudolph
PY - 2007/11
Y1 - 2007/11
N2 - Background/aims: It has been suggested that normal function of both anal sphincters is essential for a good functional outcome after colonic J-pouch-anal anastomosis (CPAA). However, CPAA patients may have impaired continence despite adequate sphincter function. The present study was designed to identify those factors, which contribute to the functional outcome after a handsewn CPAA. Materials and methods: Forty patients were studied before and 1 year after pouch surgery. Faecal continence was evaluated using the Rockwood faecal incontinence severity index (RFISI). At both occasions, maximum anal resting pressure (MARP) and maximum anal squeeze pressure (MASP) were recorded. In addition, sensory perception threshold-volumes (SPT-V) and compliance were assessed using an 'infinitely' compliant polyethylene bag connected to an electronic barostat assembly. Results: The median RFISI score 1 year after surgery was higher than the median RFISI score before surgery (13 vs 7 (p<0.01). The median MARP dropped significantly (p<0.01) whereas the median MASP remained unaffected. The mean compliance, calculated at three different sensation levels, and the pouch sensory perception threshold-volumes (PSPT-V) were lower than those of the original rectum (p<0.05). The reduction of MARP showed no correlation with the post-operative change in RFISI scores. Low PC and low PSPT-V were associated with higher RFISI scores. Conclusion: Low pouch compliance and low SPT-V adversely affect functional outcome after a handsewn colonic J-pouch-anal anastomosis.
AB - Background/aims: It has been suggested that normal function of both anal sphincters is essential for a good functional outcome after colonic J-pouch-anal anastomosis (CPAA). However, CPAA patients may have impaired continence despite adequate sphincter function. The present study was designed to identify those factors, which contribute to the functional outcome after a handsewn CPAA. Materials and methods: Forty patients were studied before and 1 year after pouch surgery. Faecal continence was evaluated using the Rockwood faecal incontinence severity index (RFISI). At both occasions, maximum anal resting pressure (MARP) and maximum anal squeeze pressure (MASP) were recorded. In addition, sensory perception threshold-volumes (SPT-V) and compliance were assessed using an 'infinitely' compliant polyethylene bag connected to an electronic barostat assembly. Results: The median RFISI score 1 year after surgery was higher than the median RFISI score before surgery (13 vs 7 (p<0.01). The median MARP dropped significantly (p<0.01) whereas the median MASP remained unaffected. The mean compliance, calculated at three different sensation levels, and the pouch sensory perception threshold-volumes (PSPT-V) were lower than those of the original rectum (p<0.05). The reduction of MARP showed no correlation with the post-operative change in RFISI scores. Low PC and low PSPT-V were associated with higher RFISI scores. Conclusion: Low pouch compliance and low SPT-V adversely affect functional outcome after a handsewn colonic J-pouch-anal anastomosis.
KW - Colonic J-pouch-anal anastomosis
KW - Functional outcome
KW - Neo-rectal wall properties
KW - Rectal cancer
KW - Total meso-rectal excision
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U2 - 10.1007/s00384-007-0326-7
DO - 10.1007/s00384-007-0326-7
M3 - Article
C2 - 17520264
AN - SCOPUS:34648835172
SN - 0179-1958
VL - 22
SP - 1353
EP - 1360
JO - International Journal of Colorectal Disease
JF - International Journal of Colorectal Disease
IS - 11
ER -
