Preservation of the anal transition zone in ulcerative colitis. Long-term effects on defecatory function

被引:12
作者
Fichera, Alessandro
Ragauskaite, Laura
Silvestri, Mark T.
Elisseou, Nicholas M.
Rubin, Michele A.
Hurst, Roger D.
Michelassi, Fabrizio
机构
[1] Univ Chicago Hosp, Dept Surg, Chicago, IL 60637 USA
[2] Univ Chicago, Dept Surg, Chicago, IL 60637 USA
[3] Cornell Univ, Weill Med Coll, Dept Surg, New York, NY USA
关键词
ulcerative colitis; colon and rectal neoplasm; cancer prevention; quality of life; surgical outcome;
D O I
10.1007/s11605-007-0321-x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Introduction The anal transition zone (ATZ) after ileal pouch anal anastomosis (IPAA) for ulcerative colitis is considered at risk for dysplasia and persistent or recurrent disease activity. The long-term fate of the ATZ and the effects of histologic changes on defecatory function are not well-known. Methods To evaluate the inflammatory and preneoplastic changes of the ATZ in patients without preoperative dysplasia, yearly biopsies of the ATZ were obtained and functional results recorded on a questionnaire/diary. Histologic changes were correlated with simultaneous assessment of defecatory function. Results Between 1992 and 2006, 225 patients underwent a stapled IPAA. A total of 238 successful biopsies of the ATZ were performed. There was no dysplasia found. Acute inflammation was noted in 4.6%, chronic inflammation in 84.9%, and normal mucosa in 10.5% of cases. Patients with chronic inflammation reported an average of 6.2 1.7 bowel movements/day and 93.2% of them were able to delay a bowel movement for at least 30 min. The presence of chronic ATZ inflammation did not seem to have a negative impact on function, with 96.1% of patients reporting perfect continence, and only 5.3% using protective pads. Conclusions Preservation of the ATZ in selected patients is safe and offers excellent long-term functional results. New onset dysplasia was not noted. Chronic inflammation had limited clinical impact. Presence of ATZ inflammation in a total of 89.5% of patients warrants life-long surveillance with biopsies.
引用
收藏
页码:1647 / 1652
页数:6
相关论文
共 29 条
[1]   Restorative proctocolectomy in patients older than fifty years [J].
Bauer, JJ ;
Gorfine, SR ;
Gelernt, IM ;
Harris, MT ;
Kreel, I .
DISEASES OF THE COLON & RECTUM, 1997, 40 (05) :562-565
[2]   Outcome after ileoanal anastomosis in pediatric patients with ulcerative colitis [J].
Durno, C ;
Sherman, P ;
Harris, K ;
Smith, C ;
Dupuis, A ;
Shandling, B ;
Wesson, D ;
Filler, R ;
Superina, R ;
Griffiths, A .
JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION, 1998, 27 (05) :501-507
[3]  
FENGER C, 1979, ACTA PATH MICRO IM A, V87, P379
[4]   FUNCTIONAL ASSESSMENT OF ILEAL POUCH-ANAL ANASTOMOTIC TECHNIQUES [J].
GEMLO, BT ;
BELMONTE, C ;
WILTZ, O ;
MADOFF, RD .
AMERICAN JOURNAL OF SURGERY, 1995, 169 (01) :137-142
[5]   Dysplasia complicating chronic ulcerative colitis - Is immediate colectomy warranted? [J].
Gorfine, SR ;
Bauer, JJ ;
Harris, MT ;
Kreel, I .
DISEASES OF THE COLON & RECTUM, 2000, 43 (11) :1575-1581
[6]  
GULLBERG K, 1995, ANN CHIR, V49, P527
[7]   Rectal cancer as a complication of stapled IPAA [J].
Hyman, N .
INFLAMMATORY BOWEL DISEASES, 2002, 8 (01) :43-45
[8]   ANAL-CANAL INFLAMMATION AFTER ILEAL POUCH-ANAL ANASTOMOSIS - THE NEED FOR TREATMENT [J].
LAVERY, IC ;
SIRIMARCO, MT ;
ZIV, Y ;
FAZIO, VW .
DISEASES OF THE COLON & RECTUM, 1995, 38 (08) :803-806
[9]   RESTORATIVE PROCTOCOLECTOMY WITH END-TO-END POUCH-ANAL ANASTOMOSIS IN PATIENTS OVER THE AGE OF 50 [J].
LEWIS, WG ;
SAGAR, PM ;
HOLDSWORTH, PJ ;
AXON, ATR ;
JOHNSTON, D .
GUT, 1993, 34 (07) :948-952
[10]   PRESERVATION OF COMPLETE ANAL SPHINCTERIC PROPRIOCEPTION IN RESTORATIVE PROCTOCOLECTOMY - THE INHIBITORY REFLEX AND FINE CONTROL OF CONTINENCE NEED NOT BE IMPAIRED [J].
LEWIS, WG ;
WILLIAMSON, MER ;
MILLER, AS ;
SAGAR, PM ;
HOLDSWORTH, PJ ;
JOHNSTON, D .
GUT, 1995, 36 (06) :902-906