Annals of Coloproctology

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Colorectal cancer

Long-term clinical outcomes after high and low ligations with lymph node dissection around the root of the inferior mesenteric artery in patients with rectal cancer: Min Wan Lee, Sung Sil Park, Kiho You, Dong Eun Lee, Dong Woon Lee, Sung Chan Park, Kyung Su Han, Dae Kyung Sohn, Chang Won Hong, Bun Kim, Byung Chang Kim, Hee Jin Chang, Dae Yong Kim, Jae Hwan Oh; Ann Coloproctol. 2024;40(1):62-73. Published online February 26, 2024; DOI: https://doi.org/10.3393/ac.2023.00094.0013

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Purpose
This study aimed to evaluate the long-term clinical outcomes based on the ligation level of the inferior mesenteric artery (IMA) in patients with rectal cancer.
Methods
This was a retrospective analysis of a prospectively collected database that included all patients who underwent elective low anterior resection for rectal cancer between January 2013 and December 2019. The clinical outcomes included oncological outcomes, postoperative complications, and functional outcomes. The oncological outcomes included overall survival (OS) and relapse-free survival (RFS). The functional outcomes, including defecatory and urogenital functions, were analyzed using the Fecal Incontinence Severity Index, International Prostate Symptom Score, and International Index of Erectile Function questionnaires.
Results
In total, 545 patients were included in the analysis. Of these, 244 patients underwent high ligation (HL), whereas 301 underwent low ligation (LL). The tumor size was larger in the HL group than in the LL group. The number of harvested lymph nodes (LNs) was higher in the HL group than in the LL group. There were no significant differences in complication rates and recurrence patterns between the groups. There were no significant differences in 5-year RFS and OS between the groups. Cox regression analysis revealed that the ligation level (HL vs. LL) was not a significant risk factor for oncological outcomes. Regarding functional outcomes, the LL group showed a significant recovery in defecatory function 1 year postoperatively compared with the HL group.
Conclusion
LL with LNs dissection around the root of the IMA might not affect the oncologic outcomes comparing to HL; however, it has minimal benefit for defecatory function.

Citations

Citations to this article as recorded by

Left colic artery–preserving radical rectal cancer surgery: a literature review
Xiyin Yang, Yuanshui Sun, Qiang Hu
Frontiers in Surgery.2026;[Epub] CrossRef
Late Anastomotic Leakage After Rectal Cancer Surgery: Incidence and Differential Risk Factors
Hyeon Kyeong Kim, In Ja Park, Jae Cheol Kang, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim
Diseases of the Colon & Rectum.2026; 69(4): 565. CrossRef
The Impact of Left Colic Artery Preservation on Complications of TaTME (Transanal Total Mesorectal Excision)
俊锋杜
Journal of Clinical Personalized Medicine.2026; 05(02): 35. CrossRef
Meeting report on the 8th Asian Science Editors’ Conference and Workshop 2024
Eun Jung Park
Science Editing.2025; 12(1): 66. CrossRef
Early detection of anastomotic leakage in colon cancer surgery: the role of early warning score and C-reactive protein
Gyung Mo Son
Annals of Coloproctology.2024; 40(5): 415. CrossRef

Anorectal physioloy

Risk factors associated with low anterior resection syndrome: a cross-sectional study: See Liang Lim, Wan Zainira Wan Zain, Zalina Zahari, Andee Dzulkarnaen Zakaria, Mohd Nizam Md Hashim, Michael Pak-Kai Wong, Zaidi Zakaria, Rosnelifaizur Ramely, Ahmad Shanwani Mohamed Sidek; Ann Coloproctol. 2023;39(5):427-434. Published online June 3, 2022; DOI: https://doi.org/10.3393/ac.2022.00227.0032

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12 Web of Science
9 Citations

Graphical Abstract Abstract PDF Supplementary Material

Purpose
Oncological outcomes following rectal cancer surgery have improved significantly over recent decades with lower recurrences and longer overall survival. However, many of the patients experienced low anterior resection syndrome (LARS). This study identified the prevalence and risk factors associated with the development of LARS.
Methods
This cross-sectional study involved patients who were diagnosed with rectal cancer and had undergone sphincter-preserving low anterior resection from January 2011 to December 2020. Upon clinic follow-up, patients were asked to complete an interviewed based questionnaire (LARS score) designed to assess bowel dysfunction after rectal cancer surgery.
Results
Out of 76 patients, 25 patients (32.9%) had major LARS, 10 patients (13.2%) had minor LARS, and 41 patients (53.9%) had no LARS. The height of tumor from anal verge showed an association with the development of major LARS (P=0.039). Those patients with less than 8 cm tumor from anal verge had an increased risk of LARS by 3 times compared to those with 8 cm and above (adjusted odds ratio, 3.11; 95% confidence interval, 1.06–9.13).
Conclusion
Results from our study show that low tumor height was a significant risk factor that has a negative impact on bowel function after surgery. The high prevalence of LARS emphasizes the need for study regarding risk factors and the importance of understanding the pathophysiology of LARS, in order for us to improve patient bowel function and quality of life after rectal cancer surgery.

Citations

Citations to this article as recorded by

Longitudinal evolution of low anterior resection syndrome in ultra-low rectal cancer: A trend analysis of a propensity-matched cohort
Han-Shuo Wang, Yu-Xin Lin, Si-Rui Xu, Li-Ya Wang, Xiao-Dong Wang, Ming-Jun Huang
World Journal of Gastroenterology.2026;[Epub] CrossRef
Score assessment and treatment in patients presenting with low anterior resection syndrome after sphincter-sparing rectal cancer surgery
R. Sguinzi, J. Fiechter, L. Bafumi, B. Gremaud, B. Geng, P. Janiak, L. Bühler, B. Egger
International Journal of Colorectal Disease.2025;[Epub] CrossRef
A randomized controlled trial of a digital lifestyle intervention involving postoperative patients with colorectal cancer
Young Il Kim, In Ja Park, Jun-Soo Ro, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim, Chang Sik Yu, Yura Lee, Yae Won Tak, Seockhoon Chung, Kyung Won Kim, Yousun Ko, Sung-Cheol Yun, Min-Woo Jo, Jong Won Lee
npj Digital Medicine.2025;[Epub] CrossRef
Impact of low anterior resection syndrome after rectal surgery on sleep quality
Akira Toyoshima, Toshihiro Nishizawa, Osamu Toyoshima, Ryuji Akai, Manabu Kaneko, Shin Sasaki
Surgery Today.2025; 55(12): 1868. CrossRef
Evaluation of the utility of a nomogram for predicting lymph node metastasis in T1 colorectal cancer in shared decision-making in clinical practice: a survey-based study
Hyeon Seung Kim, Kyung Su Han, Min Wan Lee, Dae Kyung Sohn, Chang Won Hong, Dong Woon Lee, Kiho You, Sung Chan Park, Byung Chang Kim, Bun Kim, Jae Hwan Oh
Annals of Coloproctology.2025; 41(4): 303. CrossRef
Comparative analysis of organ preservation attempt and radical surgery in clinical T2N0 mid to low rectal cancer
Hyeung-min Park, Jaram Lee, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
International Journal of Colorectal Disease.2024;[Epub] CrossRef
Beyond survival: a comprehensive review of quality of life in rectal cancer patients
Won Beom Jung
Annals of Coloproctology.2024; 40(6): 527. CrossRef
Organ preservation for early rectal cancer using preoperative chemoradiotherapy
Gyung Mo Son
Annals of Coloproctology.2023; 39(3): 191. CrossRef
Low anterior resection syndrome: is it predictable?
Dong Hyun Kang
Annals of Coloproctology.2023; 39(5): 373. CrossRef

Review

Intersphincteric Resection for Patients With Low-Lying Rectal Cancer: Oncological and Functional Outcomes: In Ja Park, Jin Cheon Kim; Ann Coloproctol. 2018;34(4):167-174. Published online August 31, 2018; DOI: https://doi.org/10.3393/ac.2018.08.02

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Abstract PDF

The aim of this review is to evaluate the outcomes after an intersphincteric resection (ISR) for patients with low-lying rectal cancer. Reports published in the literature regarding surgical, oncological, and functional outcomes of an ISR were reviewed. The morbidity after an ISR was 7.7%–32%, and anastomotic leakage was the most common adverse event. Local recurrence rates ranged from 0% to 12%, 5-year overall survival rates ranged from 62% to 92%, and rates of major incontinence ranged from 0% to 25.8% after an ISR. An ISR is a safe procedure for sphincter-saving rectal surgery in patients with very low rectal cancer; it does not compromise the oncological outcomes of the resection and is a valuable alternative to an abdominoperineal resection. While the functional outcomes after an ISR were found to be acceptable, the long-term functional outcome and quality of life still require careful investigation. ISRs have been performed with surgical and oncologic safety on patients with low-lying rectal cancer. However, patients must be selected very carefully for an ISR, considering the associated functional derangement and the limited extent of the resection.

Citations

Citations to this article as recorded by

Long-term functional and prognostic outcomes of robotic intersphincteric resection for treating low rectal cancer: a single-center retrospective study
Yang Bo, Wang Yigao, Zheng Mingye, Jian Zhao, Yongxiang Li
International Journal of Colorectal Disease.2025;[Epub] CrossRef
A randomized controlled trial of a digital lifestyle intervention involving postoperative patients with colorectal cancer
Young Il Kim, In Ja Park, Jun-Soo Ro, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim, Chang Sik Yu, Yura Lee, Yae Won Tak, Seockhoon Chung, Kyung Won Kim, Yousun Ko, Sung-Cheol Yun, Min-Woo Jo, Jong Won Lee
npj Digital Medicine.2025;[Epub] CrossRef
Comparison of quality of life between intersphincteric and abdominoperineal resection in patients with low rectal cancer
Adnan Abdulkadir Mohammed, Sara Shojaei-Zarghani, Zahra Ghanbarzadegan, Zahra Zabangirfard, Ahmed Mohammed Ali Hussein Alhurry, Khadije Gorgi, Seyed Vahid Hosseini
coloproctology.2025; 47(5): 360. CrossRef
Successful sphincter preservation and long-term survival in a patient with ultra-low locally advanced rectal cancer treated with photodynamic therapy combined with multimodal treatment: a case report and literature review
Dan Zou, Baohong Gu, Yifan Li, Ying Yan, Huanhuan Ma, Kai Wang, Weiyi Chen, Bofang Wang, Hao Chen
Therapeutic Advances in Medical Oncology.2025;[Epub] CrossRef
Long-term efficacy and short-term outcomes of intersphincteric resection vs abdominoperineal resection in patients with ultra-low rectal cancer
Guan-Cong Wang, Jun-Xing Chen, Hong-Feng Pan, Kai Ye, Yin-Cong Guo, Ying Huang
World Journal of Gastroenterology.2025;[Epub] CrossRef
Oncologic outcomes of intersphincteric resection versus abdominoperineal resection for lower rectal cancer: a systematic review and meta-analysis
Qiang Du, Wenming Yang, Jianhao Zhang, Siyuan Qiu, Xueting Liu, Yong Wang, Lie Yang, Zongguang Zhou
International Journal of Surgery.2024; 110(4): 2338. CrossRef
Does anastomotic leakage after intersphincteric resection for ultralow rectal cancer influence long-term outcomes? A retrospective observational study
Feifan Liu, Bin Zhang, Jianbin Xiang, Guangzuan Zhuo, Yujuan Zhao, Yiming Zhou, Jianhua Ding
Langenbeck's Archives of Surgery.2023;[Epub] CrossRef
Comparative study of functional outcomes between ultra‐low anterior resection and inter‐sphincteric resection: a propensity matched analysis
Jayesh Gori, Mufaddal Kazi, Barath Rajkumar, Prajesh Bhuta, Suman Kumar Ankathi, Ashwin Desouza, Avanish Saklani
ANZ Journal of Surgery.2022; 92(1-2): 151. CrossRef
Current status and role of robotic approach in patients with low-lying rectal cancer
Hyo Seon Ryu, Jin Kim
Annals of Surgical Treatment and Research.2022; 103(1): 1. CrossRef
Trans-Anastomotic Drainage Tube Placement After Hand-Sewn Anastomosis in Patients Undergoing Intersphincteric Resection for Low Rectal Cancer: An Alternative Drainage Method
Xinjian Zhong, Xiaoyu Xie, Hang Hu, Yi Li, Shunhua Tian, Qun Qian, Congqing Jiang, Xianghai Ren
Frontiers in Oncology.2022;[Epub] CrossRef
Functional outcomes of intersphincteric resection in low rectal tumors
Osman Bozbıyık, Cemil Çalışkan, Özgün Köse, Ozan Verendağ, Berk Göktepe, Tayfun Yoldaş, Erhan Akgün, Mustafa Ali Korkut
Turkish Journal of Surgery.2022; 38(2): 180. CrossRef
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Diwakar Pandey, Vivek Sukumar, Avanish Saklani
JAMA Surgery.2021; 156(2): 202. CrossRef
Local recurrence with intersphincteric resection in adverse histology rectal cancers. A retrospective study with competing risk analysis
Ashwin L. Desouza, Mufaddal Kazi, Kamlesh Verma, Pavan Sugoor, Balu K. Mahendra, Avanish P. Saklani
ANZ Journal of Surgery.2021; 91(11): 2475. CrossRef
A case of effective Delorme’s procedure for colonic mucosal prolapse after intersphincteric resection
Akihiro Kohata, Wataru Shimizu, Masatoshi Kochi, Yuji Takakura, Hideki Ohdan
Journal of Surgical Case Reports.2021;[Epub] CrossRef
Oncologic and Functional Outcomes of Pelvic Perineal Reconstruction by Perineal Colostomy and Malone Procedure After Abdominoperineal Resection
Anthony Marinho, Nicolas Zalay, Léonor Chaltiel, Sylvain Kirzin, Antoine Philis, Jannick Selves, Nicolas Carrère, Etienne Buscail, Laurent Ghouti
Diseases of the Colon & Rectum.2021; 64(12): 1501. CrossRef
Functional outcomes after sphincter-preserving surgeries for low-lying rectal cancer: A review
Eun Jung Park, Seung Hyuk Baik
Precision and Future Medicine.2021; 5(4): 164. CrossRef
Robotic Intersphincteric Resection for Low Rectal Cancer: Technical Controversies and a Systematic Review on the Perioperative, Oncological, and Functional Outcomes
Guglielmo Niccolò Piozzi, Seon Hahn Kim
Annals of Coloproctology.2021; 37(6): 351. CrossRef
Surgical Treatment of Low-Lying Rectal Cancer: Updates
Cristopher Varela, Nam Kyu Kim
Annals of Coloproctology.2021; 37(6): 395. CrossRef
Oncologic safety and bowel function after ultralow anterior resection with or without intersphincteric resection for low lying rectal cancer: Comparative cross sectional study
Ahmad Sakr, Seung Yoon Yang, Jae Hyun Kang, Min Soo Cho, Yoon Dae Han, Byung Soh Min, Waleed Thabet, Hosam Ghazy Elbanna, Mosaad Morshed, Nam Kyu Kim
Journal of Surgical Oncology.2020; 121(2): 365. CrossRef
Simplification or Accuracy: In Assessing Functional Outcomes After Intersphincteric Resection for Low Rectal Cancer
Kyung Jong Kim
Annals of Coloproctology.2020; 36(3): 129. CrossRef
Avoidance of Overtreatment of Rectal Cancer by Selective Chemoradiotherapy: Results of the Optimized Surgery and MRI-Based Multimodal Therapy Trial
Reinhard Ruppert, Rainer Kube, Joachim Strassburg, Andreas Lewin, Joerg Baral, Christoph A. Maurer, Joerg Sauer, Theodor Junginger, Paul Hermanek, Susanne Merkel, Martin E. Kreis, Guenther Winde, Rena Thomasmeyer, Sigmar Stelzner, Cornelius Bambauer, Soen
Journal of the American College of Surgeons.2020; 231(4): 413. CrossRef
Latest Advances in Intersphincteric Resection for Low Rectal Cancer
Yifan Xv, Jiajun Fan, Yuan Ding, Yang Hu, Yingjie Hu, Zhengjie Jiang, Qingsong Tao
Gastroenterology Research and Practice.2020; 2020: 1. CrossRef
Nachsorge und Behandlung funktioneller Störungen nach operativer Therapie des Rektumkarzinoms
C. Holmer
Der Onkologe.2020; 26(12): 1154. CrossRef
Factors influencing changing bowel habits in patients undergoing sphincter‐saving surgery for rectal cancer
Hyeonju Jeong, JeongYun Park
International Wound Journal.2019; 16(S1): 71. CrossRef
Postoperative Bowel Function After Anal Sphincter-Preserving Rectal Cancer Surgery: Risks Factors, Diagnostic Modalities, and Management
Chris George Cura Pales, Sanghyun An, Jan Paolo Cruz, Kwangmin Kim, Youngwan Kim
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Long Term Results of Modified Intersphincteric Resections for Low Rectal Cancer: A Single Center Experience
Vlad-Olimpiu Butiurca, Călin Molnar, Copotoiu Constantin, Marian Botoncea, Teodor Ioan Bud, Zsolt Kovacs, Cătălin Satala, Simona Gurzu
Medicina.2019; 55(12): 764. CrossRef

Original Articles

The Clinical Results of a Total Proctocolectomy with an Ileal Pouch-Anal Anastomosis: 12 Cases.: Lee, Gyoung Chun , Lee, Seung Hyun , Ahn, Byung Kwon , Baek, Sung Uhn; J Korean Soc Coloproctol. 2003;19(1):6-12.

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Abstract PDF: PURPOSE
A restorative proctocolectomy has been accepted as the operation of choice for ulcerative colitis and familial adenomatous polyposis. The purpose of this study was to assess the postoperative complications and functional outcomes following a total proctocolectomy with a J ileal pouch-anal anastomosis.
METHODS
The medical records of 12 patients who had undergone a total proctocolectomy, with a J ileal pouch-anal anastomosis, between January 1997 and June 2002, were retrospectively reviewed according to sex, age, underlying disease and postoperative complications. We evaluated the functional outcomes using medical record reviews and patients and telephone interviews.
RESULTS
Total proctocolectomy, with a J ileal pouch-anal anastomosis, were done for ulcerative colitis (n=2) and familial adenomatous polyposis (n=10). A diverting ileostomy was performed in 8 patients. Postoperative complications occurred in 7 patients (58%), intestinal obstructions in 4 and complications related with anastomosis in 3, i.e. J ileal pouch leakage (n=2) and ileal pouch-vaginal fistula (n=1). Re-operations, due to postoperative complications, were performed in 4 patients, i.e. small bowel segmental resection (n=1), adhesiolysis (n=1), diverting ileostomy (n=1) and ileal pouch resection & reconstruction (n=1). The daily median defecation frequencies were 7.7 (range 4~20) a month after the operation, 5.4 (3~12) at 2~3 months, 4.5 (3~7) at 6 months and 4.1 (3~5) at 12 months, following the operation. Two patients had gas incontinence, 1 had fluid incontinence, 4 had night soiling and 3 needed pads, but these incontinences, the need for anti-diarrhea medication and the use of pads, all improved within 6 months of the operation. Fluid incontinence and the use of pads improved within 3 months of the operation, gas incontinence and night soiling improved within 6 months of the operation. The mean length of follow-up was 30.6 months.
CONCLUSIONS
The postoperative complication rate was 58%. Thirty-three percent of patients had fecal incontinence, but all these improved within 6 months. The long- term functional outcomes, after a total proctocolectomy with J ileal pouch-anal anastomosis, were satisfactory, and the postoperative complications acceptable. The postoperative complication rates were no different between the protective diverting ileostomy and non-ileostomy .

Is the Level of Anastomosis within the Anal Canal Pertinent to Physiologic and Functional Outcome in the Double-stapled Ileoanal Reservoir?.: Choi, Hong Jo , Choi, Jeong Seok , Saigusa, Naoto , Shin, Eung Jin , Weiss, Eric G , Nogueras, Juan J , Wexner, Steven D; J Korean Soc Coloproctol. 2001;17(6):295-303.

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Abstract PDF: PURPOSE
The aims of this investigation were to access the relative ratio of epithelial types within the anal canal after a double-stapled ileoanal reservoir (DSIAR) and to review physiologic and functional differences based on this diversity in epithelial types.
METHODS
According to types of the epithelium present at histologic sections of the distally excised tissue ring ("donut") after the stapling for restorative proctocolectomy with construction of a DSIAR, one hundred thirty-eight patients with ulcerative colitis were stratified into two groups: 40 patients (22 males and 18 females) were categorized to be of lower anastomosis (group I), where squamous, squamous mixed with columnar, or squamocuboidal component was reported to be present, and 98 patients (50 males and 48 females) to be of higher one (group II), which was evidenced by columnar epithelium at the "donut". Physiologic and functional parameters were appraised between 2 groups to define whether this difference in epithelial types is associated with a significant difference in postoperative anorectal functional outcome.
RESULTS
None of preoperative parameters reflecting resting and squeeze pressures showed significant differences between 2 groups. Postoperative mean and maximal resting pressures (MRP and MxRP) were declined to 48.8 16.9 mmHg and 67.1 21.3 mmHg in group I, and 61.1 22.7 mmHg and 90.0 38.6 mmHg in group II, differences of which were significant (P=0.046 and 0.031, respectively). Neither postoperative mean nor maximal squeeze pressure was, however, statistically different between 2 groups. Mean length of the high pressure zone was decreased in both groups postoperatively, but there were no intergroup differences. Rectoanal inhibitory reflex decreased significantly from 97.4% to 50% in group I and from 86.5% to 53.9% in group II, respectively (P<0.0001 in both). However, there was no significant intergroup difference postoperatively. Maximal tolerance volume and compliance of the reservoir were significantly improved postoperatively in both groups; from 52.2 26.1 ml and 2.8 3.3 to 163.3 115.7 ml and 14.7 15.3 in group I (P=0.0001, and <.0001, respectively), and from 77.0 59.5 ml and 4.4 6.8 to 167.3 87.9 ml and 28.7 44.0 in group II (P<0.0001, both). But there was no intergroup difference in either parameters postoperatively. There were no significant differences between groups relative to functional outcome except the diurnal incontinence to solid stool (P<0.011).
CONCLUSIONS
Although epithelial types were shown to be variable at the anal side of the anastomosis after a DSIAR, these differences were not associated with physiologic and functional differences. Therefore, if technically feasible, this procedure can be performed with safety without fear of significant functional derangement.

Manometric Assessment after Ileal Pouch- Anal Anastomosis.: Yu, Chang Sik , Kim, Hee Chul , Park, Sang Gyu , Kim, Sook Young , Cho, Young Gyu , Hong, Hyun Ki , Kim, Jin Cheon; J Korean Soc Coloproctol. 2001;17(4):187-192.

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Abstract PDF: PURPOSE
Functional derangement in bowel movement after ileal pouch-anal anastomosis (IPAA) is not infrequent. It results from several mechanisms mainly decreased rectal reservoir capacity and rectal sensation. Anal sphincter or pelvic nerve damage during surgery contributes physiological changes, also. This study was performed to evaluate manometric changes after IPAA and compare them with functional outcomes regarding anastomotic technique.
METHODS
Forty seven (M:F=23:24) patients who underwent IPAA and manometric assessment were enrolled. Pathological diagnoses of them were 32 ulcerative colitis, 12 familial adenomatous polyposis, and 3 hereditary non-polyposis colorectal cancer. Every pouch was constructed in J shape, 15cm length. Pouch-anal anastomosis was performed by 27 hand-sewn and 20 double stapling technique. Diverting ileostomy was performed in 30 cases (64%) and closed 2-3 months after IPAA. Manometry was performed preoperatively and 3 to 6 months interval, postoperatively. Twenty two patients underwent full manometic assessment pre- and post-operatively. The others did it either pre or postsoperatively. Functional outcome was investigated at the median follow-up period 25 (2-54) months. Statistical analysis was performed by using Chi- square and Fisher's exact test. Significance was assigned to a P value of <0.05.
RESULTS
Maximum resting pressure (MRP) was significantly decreased postoperatively (85.2 vs. 60.6 mmHg; P=0.002). This phenomenon could be observed throughout the follow-up period. However, the difference was getting smaller as times went by. Rectoanal inhibitory reflex (RAIR) was identified 96% preoperatively, and only 22% postoperatively (P=0.000). Rectal compliance was decreased at the time of ileostomy closure, and improved remarkably since 6 months after closure. In comparison of manometric findings according to anastomotic technique, MRP in hand- sewn group was significantly decreased (52.3 vs. 77.0 mmHg; P=0.003). RAIR could be identified more frequently in double stapled group (31.6 vs. 15.4%; P>0.05). Postoperative stool frequency and incontinence rate were not different between two groups. Thirty one percent of patients revealed night time seepage. MRP of this seepage group was significantly lower than the other group (67.9 vs. 48.4 mmHg; P=0.038).
CONCLUSIONS
Characteristic changes of manometric findings after IPAA were summarized as decrease of MRP and disappearance of RAIR. Rectal compliance was significantly improved since 6 months after IPAA or ileostomy closure. Decrease of MRP was more remarkable in hand-sewn group. However, we could not find any difference in functional outcomes between two anastomotic techniques. MRP was a crutial factor for postoperative seepage.

Functional Outcome after Ileal J-pouch Anal Anastomosis in Patients with Ulcerative Colitis.: Yoon, Sang Nam , Hong, Chang Won , Lee, Min Ro , Park, Kyu Joo; J Korean Soc Coloproctol. 2004;20(5):263-270.

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Abstract PDF: PURPOSE
This study was performed to assess the complications and functional outcomes after a total proctocolectomy and ileal J-pouch anal anastomosis for patients with ulcerative colitis.
METHODS
We reviewed the medical records of 30 patients who had undergone a total proctocolectomy and ileal J-pouch anal anastomosis for ulcerative colitis from 1992 to 1999 in our hospital. We used questionnaires or telephone interviews to assess the functional outcomes of the patients. The median duration of follow-up was 23 months after the ileostomy take down.
RESULTS
The mean age of the patients at the definitive operation was 35.9 (+/-11.8). The indications for operation were medical intractability (76.7%), suspicious malignancy (13.3%), perforation (6.7%), and hemorrhage (3.3%). The double stapling method was used in 26 patients and the handsewn method in 4 patients. Of the 30 patients, 23 patients completed the functional analysis. Bowel frequency was 6.6 (+/- 2.6) per 24 hours, with 5.1 (+/- 2.1) in the daytime and 1.4 (+/-1.3) in the night. Fourteen patients (60.9%) had relatively mild incontinence, and four patients (17.4%) had to wear pads, especially at night. Eighteen patients (78.3%) were able to discriminate flatus from feces, and only one patient (4.3%) suffered from perianal irritation. Twelve patients (52.2%) had to restrict their diets, and five patients (21.7%) took antidiarrheal medications. Pouchitis occurred in three patients (13.0%). Sexual dysfunction was noted in four patients (17.4%), and urinary urgency in one patient (4.3%). There was no functional difference between the double stapling method and the handsewn method.
CONCLUSIONS
The functional outcomes after ileal J-pouch anal anastomosis for patients with ulcerative colitis were satisfactory, irrespective of the method of anastomosis.

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