Anal Sphincter Function After Colectomy, Mucosal Proctectomy, and Endorectal Ileoanal Pull-through

• Anal sphincter function in patients before and after colectomy, mucosal proctectomy, and endorectal ileoanal pullthrough was assessed prospectively. In 21 patients with ulcerative colitis, Gardner's syndrome, or familial polyposis, anorectal manometry was performed before and eight weeks after ileoanal pull-through. The mean±SEM maximal anal sphincter resting pressure decreased from 86±5 to 68±4 mm Hg after operation. The net change in pressure with squeeze, however, was greater after ileoanal pull-through than before operation (100±9 v 92±7 mm Hg). In 19 of 21 patients after operation, balloon dilation of the ileal pouch resulted in relaxation of the internal anal sphincter and contraction of the external anal sphincter. Mean±SEM 24-hour stool frequency decreased from 7.6±0.6 at one month to 6.2±0.5 at three months. It was concluded that ileoanal pull-through preserves continence and an acceptable stool frequency by maintaining nearly normal anal sphincter function.

(Arch Surg 1984;119:526-531)