Ileal pouch anal function after endoanal mucosectomy and handsewn ileoanal anastomosis compared with stapled anastomosis without mucosectomy.

OBJECTIVE: To compare manovolumetric results and functional outcome after restorative proctocolectomy with either mucosal proctectomy and handsewn pouch-anal anastomosis or stapling. DESIGN: Prospective randomised study. SETTING: University hospital, Sweden. SUBJECTS: 80 Consecutive patients undergoing restorative proctocolectomy. INTERVENTIONS: 37 patients were randomised to have mucosectomy and a handsewn anastomosis and 43 patients to have a stapled anastomosis. MAIN OUTCOME MEASURES: Comparisons of anal sphincter function and clinical outcome in terms of continence and overall functional score between the two groups of patients. RESULTS: There was persistent reduction in anal resting tone at one year amounting to 29% in the handsewn group and and to 21% in the stapled group (p < 0.001 compared with preoperative in both groups). Daytime continence was similar, but patients with stapled anastomoses experienced less soiling during sleep, especially in the early postoperative period (5/43, 12% compared with 15/33, 45% at one month, p < 0.001). The arbitrary overall functional score was, however, similar in both groups. CONCLUSION: Handsewn and stapled ileal pouch-anal anastomoses result in similar postoperative anal sphincter impairment and overall clinical outcome.

Long-term follow-up in Crohn's disease. Mortality, morbidity, and functional status.

BACKGROUND: The purpose of this study was to analyse long-term results of an active approach to surgical treatment of Crohn's disease. METHODS: One hundred and thirty-six patients were studied after first resection for primary Crohn's disease during 1968-77. RESULTS: Mean follow-up was 16.6 years; 18 patients had died (3 of Crohn's disease). Cumulative risk for a second resection was 0.40 (95% confidence interval, 0.29-0.51) at 10 years and 0.45 (0.32-0.58) at 15 years, similar in classical disease and colitis. Cumulative risk of a third and fourth resection was 0.5 at 10 years. Median resected bowel length at the first operation was 8%. After two and three resections the cumulative resection was 23% and 33%, respectively. Of the patients 73% claimed full working capacity and 7% had disability pension. CONCLUSIONS: An active surgical approach in Crohn's disease is associated with low operative mortality and morbidity and good functional results and offers good symptomatic relief.