Surgical treatment and role of dynamic defecography after ileal pouch-anal anastomosis: technical solutions to a difficult problem.

Abstract

Patients with an ileal pouch-anal anastomosis may develop impaired evacuation of the pouch. A new surgical approach and the role of dynamic defecography in such patients are highlighted. Five patients with ileal pouch-anal anastomosis were assessed clinically and with dynamic defecography before and after reoperation. In one patient an extensive approach with complete pouch mobilization, stenoplasty of a pouch outlet stenosis, shortening of the rectal remnant, and renewed pouch-anal anastomosis were needed; in three patients, a long and angulated efferent limb was shortened by transabdominal techniques (stenoplasty or a newly developed technique with a linear stapler), and in one patient a pouch inlet stenosis was corrected. In all patients, impaired emptying was cured; in all patients, obstructive abdominal pain improved considerably. Dynamic defecography is indispensable for tailoring surgical treatment. Effective transabdominal shortening of the efferent limb can be performed with the aid of a linear stapler.