Functional assessment after colectomy, mucosal proctectomy, and endorectal ileoanal pull‐through

Radiographic, manometric, and clinical techniques were used to assess the functional results after colectomy, mucosal proctectomy, and endorectal ileoanal pull‐through (IAP). In 40 patients with ulcerative colitis, Gardner's syndrome, or familial polyposis, anorectal manometry was performed before IAP and 2 months and 1 year afterward. At 4 weeks after IAP, a standardized water contrast radiograph allowed an estimation of the dimensions of the ileal pouch and the integrity of the ileoanal anastomosis. Radiographically, the mean ± SE length, width, and depth of the ileal pouch were 10.9±0.6 cm, 4.5±0.6 cm, and 3.9±0.2 cm, respectively. No anastomotic leaks were identified; however, 2 patients were incontinent to the contrast material. The mean maximal anal sphincter resting pressure decreased from a mean ± SEM of 87.1±3.2 mmHg preoperatively to 68.1±3.1 mmHg 8 weeks after operation, but by 1 year resting pressure increased to 72.3 ±4.9 mmHg. The change in sphincter pressure with voluntary squeeze was greater 8 weeks after IAP than before the operation (114.0±8.2 mmHg versus 97.7±6.2 mmHg) and increased further by 1 year. No patient experienced major episodes of incontinence. Mean ± SEM stool frequency per 24 hours decreased from 7.5±0.5 at 1 month after ileostomy closure to 6.4±0.7 at 12 months. Ileal pouch capacity increased with time and was inversely related to stool frequency. It was concluded that endorectal pull‐through of an ileal J pouch, by providing an adequate intestinal reservoir and preserving nearly normal anal sphincter function, results in anal continence and acceptable stool frequency.