The choice of mucosectomy and hand-sewn versus stapled ileal pouch-anal anastomosis has been a subject of debate.
There is no clear consensus as to which method provides better functional results and long-term outcomes.
Dr Richard Lovegrove and colleagues compared outcomes of stapled versus hand-sewn pouch-anal anastomosis after restorative proctocolectomy.
The research team used meta-analytical techniques.
Studies published between 1988 and 2003 of hand-sewn versus stapled ileal pouch-anal anastomosis were included.
Endpoints included functional and physiologic outcomes at least 3 months following closure of ileostomy or surgery if no proximal diversion was used.
Quality of life following surgery, and neoplastic transformation within the anal transition zone were also measured.The researchers identified 21 studies, consisting of 4183 patients.
|The incidence of pad usage favored stapled pouch-anal anastomosis|
|Annals of Surgery|
Of the identified patients, 2699 underwent hand-sewn techniques and 1484 received stapled ileal pouch-anal anastomosis.
The team found no significant difference in the incidence of postoperative complications between the 2 groups.
The incidence of nocturnal seepage and pad usage favored the stapled ileal pouch-anal anastomosis.
The team noted that the frequency of defecation was not significantly different between the 2 groups, nor was the use of antidiarrheal medication.
Anorectal physiologic measurements showed a reduction in the resting and squeeze pressure in the hand-sewn ileal pouch-anal anastomosis group by 13 and 14 mm Hg, respectively.
The stapled ileal pouch-anal anastomosis group showed a higher incidence of dysplasia in the anal transition zone that did not reach statistical significance.
Dr Lovegrove's team concluded, “Both techniques had similar early postoperative outcomes.”
“Stapled ileal pouch-anal anastomosis offered improved nocturnal continence, which was reflected in higher anorectal physiologic measurements.”
“A risk of increased incidence of dysplasia in the anal transition zone may exist in the stapled group that cannot be quantified by this study.”
“They describe a decision algorithm for the choice of ileal pouch-anal anastomosis, based on the relative risk of long-term neoplastic transformation.”