Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1986 Jan;203(1):55–61. doi: 10.1097/00000658-198601000-00010

Anal and neorectal function after ileal pouch-anal anastomosis.

S J Stryker, K A Kelly, S F Phillips, R R Dozois, R W Beart Jr
PMCID: PMC1251039  PMID: 3942422

Abstract

Bowel function varies markedly among patients with colectomy and ileal pouch-anal anastomosis. Little is known of the mechanisms controlling fecal continence and frequency of defecation after operation. The aim of this study was to determine which features of the anal sphincter and neorectum accounted for the variation in clinical outcome. Twenty patients were studied 4 to 35 months after operation and compared to 12 healthy volunteers. Despite several patients exhibiting impaired fecal continence, anal sphincteric length and pressures and ileal pouch capacity and distensibility were similar in patients and controls. Patients with poor results, however, had rapid filling of their ileal pouch, which resulted in early onset of high amplitude propulsive pressure waves in the pouch. As these waves became more frequent, defecation resulted. Patients with poor results also were not able to empty adequately their pouch. The poorer the completeness of evacuation, the more frequent the defecation (r = 0.62, p less than 0.01). The authors conclude that rapid pouch filling and impaired pouch evacuation can lead to increased stool frequency in patients after ileal pouch-anal anastomosis.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ALLEN G. L., POOLE E. W., CODE C. F. RELATIONSHIPS BETWEEN ELECTRICAL ACTIVITIES OF ANTRUM AND DUODENUM. Am J Physiol. 1964 Oct;207:906–910. doi: 10.1152/ajplegacy.1964.207.4.906. [DOI] [PubMed] [Google Scholar]
  2. Akwari O. E., Kelly K. A., Phillips S. F. Myoelectric and motor patterns of continent pouch and conventional ileostomy. Surg Gynecol Obstet. 1980 Mar;150(3):363–371. [PubMed] [Google Scholar]
  3. Arndorfer R. C., Stef J. J., Dodds W. J., Linehan J. H., Hogan W. J. Improved infusion system for intraluminal esophageal manometry. Gastroenterology. 1977 Jul;73(1):23–27. [PubMed] [Google Scholar]
  4. Azpiroz F., Malagelada J. R. Pressure activity patterns in the canine proximal stomach: response to distension. Am J Physiol. 1984 Sep;247(3 Pt 1):G265–G272. doi: 10.1152/ajpgi.1984.247.3.G265. [DOI] [PubMed] [Google Scholar]
  5. Duthie H. L., Bennett R. C. The relation of sensation in the anal canal to the functional anal sphincter: a possible factor in anal continence. Gut. 1963 Jun;4(2):179–182. doi: 10.1136/gut.4.2.179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Fonkalsrud E. W. Endorectal ileoanal anastomosis with isoperistaltic ileal reservoir after colectomy and mucosal proctectomy. Ann Surg. 1984 Feb;199(2):151–157. doi: 10.1097/00000658-198402000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Gadacz T. R., Kelly K. A., Phillips S. F. The continent ileal pouch: absorptive and motor features. Gastroenterology. 1977 Jun;72(6):1287–1291. [PubMed] [Google Scholar]
  8. Heppell J., Kelly K. A., Phillips S. F., Beart R. W., Jr, Telander R. L., Perrault J. Physiologic aspects of continence after colectomy, mucosal proctectomy, and endorectal ileo-anal anastomosis. Ann Surg. 1982 Apr;195(4):435–443. doi: 10.1097/00000658-198204000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. McLeod G. M., French A. B., Good C. J., Wright F. S. Gastrointestinal absorption and biliary excretion of phenolsulfonphthalein (phenol red) in man. J Lab Clin Med. 1968 Feb;71(2):192–200. [PubMed] [Google Scholar]
  10. Neal D. E., Williams N. S., Johnston D. Rectal, bladder and sexual function after mucosal proctectomy with and without a pelvic reservoir for colitis and polyposis. Br J Surg. 1982 Oct;69(10):599–604. doi: 10.1002/bjs.1800691015. [DOI] [PubMed] [Google Scholar]
  11. Nicholls J., Pescatori M., Motson R. W., Pezim M. E. Restorative proctocolectomy with a three-loop ileal reservoir for ulcerative colitis and familial adenomatous polyposis. Clinical results in 66 patients followed for up to 6 years. Ann Surg. 1984 Apr;199(4):383–388. doi: 10.1097/00000658-198404000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Parks A. G. Royal Society of Medicine, Section of Proctology; Meeting 27 November 1974. President's Address. Anorectal incontinence. Proc R Soc Med. 1975 Nov;68(11):681–690. [PMC free article] [PubMed] [Google Scholar]
  13. Phillips S. F., Edwards D. A. Some aspects of anal continence and defaecation. Gut. 1965 Aug;6(4):396–406. doi: 10.1136/gut.6.4.396. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Rabau M. Y., Percy J. P., Parks A. G. Ileal pelvic reservoir: a correlation between motor patterns and clinical behaviour. Br J Surg. 1982 Jul;69(7):391–395. doi: 10.1002/bjs.1800690712. [DOI] [PubMed] [Google Scholar]
  15. Read N. W., Bartolo D. C., Read M. G. Differences in anal function in patients with incontinence to solids and in patients with incontinence to liquids. Br J Surg. 1984 Jan;71(1):39–42. doi: 10.1002/bjs.1800710112. [DOI] [PubMed] [Google Scholar]
  16. Read N. W., Harford W. V., Schmulen A. C., Read M. G., Santa Ana C., Fordtran J. S. A clinical study of patients with fecal incontinence and diarrhea. Gastroenterology. 1979 Apr;76(4):747–756. [PubMed] [Google Scholar]
  17. Stryker S. J., Borody T. J., Phillips S. F., Kelly K. A., Dozois R. R., Beart R. W., Jr Motility of the small intestine after proctocolectomy and ileal pouch-anal anastomosis. Ann Surg. 1985 Mar;201(3):351–356. doi: 10.1097/00000658-198503000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Stryker S. J., Daube J. R., Kelly K. A., Telander R. L., Phillips S. F., Beart R. W., Jr, Dozois R. R. Anal sphincter electromyography after colectomy, mucosal rectectomy, and ileoanal anastomosis. Arch Surg. 1985 Jun;120(6):713–716. doi: 10.1001/archsurg.1985.01390300063011. [DOI] [PubMed] [Google Scholar]
  19. Taylor B. M., Beart R. W., Jr, Dozois R. R., Kelly K. A., Phillips S. F. Straight ileoanal anastomosis v ileal pouch--anal anastomosis after colectomy and mucosal proctectomy. Arch Surg. 1983 Jun;118(6):696–701. doi: 10.1001/archsurg.1983.01390060018004. [DOI] [PubMed] [Google Scholar]
  20. Taylor B. M., Beart R. W., Jr, Phillips S. F. Longitudinal and radial variations of pressure in the human anal sphincter. Gastroenterology. 1984 Apr;86(4):693–697. [PubMed] [Google Scholar]
  21. Taylor B. M., Cranley B., Kelly K. A., Phillips S. F., Beart R. W., Jr, Dozois R. R. A clinico-physiological comparison of ileal pouch-anal and straight ileoanal anastomoses. Ann Surg. 1983 Oct;198(4):462–468. doi: 10.1097/00000658-198310000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES