Anal Sphincter Function After Colectomy, Mucosal Proctectomy, and Endorectal Ileoanal Pull-through

Anal sphincter function in patients before and after colectomy, mucosal proctectomy, and endorectal ileoanal pull-through was assessed prospectively. In 21 patients with ulcerative colitis, Gardner's syndrome, or familial polyposis, anorectal manometry was performed before and eight weeks after ileoanal pull-through. The mean +/- SEM maximal anal sphincter resting pressure decreased from 86 +/- 5 to 68 +/- 4 mm Hg after operation. The net change in pressure with squeeze, however, was greater after ileoanal pull-through than before operation (100 +/- 9 v 92 +/- 7 mm Hg). In 19 of 21 patients after operation, balloon dilation of the ileal pouch resulted in relaxation of the internal anal sphincter and contraction of the external anal sphincter. Mean +/- SEM 24-hour stool frequency decreased from 7.6 +/- 0.6 at one month to 6.2 +/- 0.5 at three months. It was concluded that ileoanal pull-through preserves continence and an acceptable stool frequency by maintaining nearly normal anal sphincter function.