J.Jpn. Surg. Soc.
ISSN 1880-1129

[Abstract] [Full Text PDF] （in Japanese / 1452KB） [Members Only And Two Factor Auth.]

J.Jpn. Surg. Soc.. 98(4): 457-461, 1997

Feature topic

PRESERVATION OF ANAL TRANSITIONAL ZONE IN RESTORATIVE PROCTODECTOMY

1) Yokohama City Hospital, Yokohama, Japan
2) Second Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan
3) First Department of Surgery Faculty of Medicine, The University of Tokyo, Tokyo, Japan

Tsuneo Fukushima1), Fumihiko Kito1), Yoshiro Obi1), Akira Ishiyama1), Keigo Matsuo1), Akira Sugita2), Kazutaka Koganei2), Masaru Shinozaki3)

Since 1980, restorative proctocolectomy has been established for surgical therapy to ulcerative colitis. The crucial points of this procedure are mucosectomy of the anorectal mucosa and pouch anal anastomosis. Mucosectomy is often difficult due to long standing acute and chronic inflammation and incomplete microscopically and leakage of pouch anal anastomosis is relatively high probably due to steroid given prior to surgery or direct effect of anorectal mucosal inflammation. Regards to postoperative bowel function, nocternal soiling is frequently recognized in the patients who received this operation.
To overcome these technical and functional disadvantages, anal transitional zone preservation without mucosectomy and stapled anastomosis between pouch and the upper rim of the puborectalis muscle has been performed. Our series of 84 cases with this modified method, anastomotic leakage was significantly decreased and nocternal soiling was completely disappeared within 7 months postoperatively. And one stage procedure bacame possible unless severe, or high dosis of steroid given prior to surgery. Only one case of mild dysplasia was experienced in the remaining rectal mucosa which was disappeared at the next examination. Medical treatment to the remaining lesion was not tnecessary in the most of cases. Anal canal preservation is suprior to mucosectomy in the points of bowel function and minimizing postoperative complications.

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