Abdominal mucosectomy reduces the incidence of soiling and sphincter damage after restorative proctocolectomy and J-pouch

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Abstract
Thirty-two ileoanal J-pouch procedures have been performed by the author between 1983 and 1986. Two pouches have been excised, one has been defunctioned for diarrhea, and seven patients either have not had their ileostomy closed or have not been followed for more than four months after restoration of intestinal continuity. Of the remaining 22 patients, 12 early operations involved endoanal mucosectomy while in the ten most recent procedures, the rectum and anal mucosa have been excised from the abdomen. Incidence of complications between the methods of mucosal excision were comparable apart from cuff abscess (n = 5) which only occur after endoanal muscosectomy. Functional results were identical apart from the incidence of soiling which occurred in six of 12 patients after endoanal mucosectomy but in only one of ten patients after abdominal mucosectomy. Resting anal canal pressures fell significantly after endoanal mucosectomy (87 to 60 cm H2O, P < 0.05) but not after abdominal mucosectomy (82 to 81 cm H2O). These differences may be due to the duration and extent of anal retraction, which was 72 minutes after endoanal mucosectomy but only 18 minutes after abdominal mucosectomy. Abdominal mucosectomy appears to cause less sphincter damage and soiling than conventional endoanal excision.