Abstract
Restorative proctocolectomy with various types of reservoir is widely used in the elective surgery of ulcerative colitis and familial adenomatous polyposis. Both, advantages and disadvantages of this procedure are well known and documented. Straight ileo-anal anastomosis (IAA) yields unsatisfactory clinical results due to the lack of storage capacity of the distal ileum and the frequency of bowel movements related to high pressure ileal waves. In an attempt to create an alternative to the above procedures, we have performed a straight ileo-anal anastomosis with two rectangular (10 cmx1 cm) myectomies down to 2 cm, above the anastomotic line. The two myectomies are spaced at 120° to each other and to the mesenteric border of the ileal loop. The rationale of this approach is to reduce the peristaltic drive of the ileum by weakening the muscular wall. This study presents the results in three patients operated on with this new method in the last year.
Résumé
Le rétablissement de la continuité avec différents types de réservoirs après proctocolectomie est actuellement largement utilisé pour le traitement chirurgical électif de la colite ulcéro-hémorragique et de la polypose familiale. Les avantages et les inconvénients de cette technique sont bien connus et bien documentés. Les anastomoses iléoanales directes donnent de mauvais résultats cliniques en raison de l'absence d'une capacité de réservoir de l'iléon distal et en raison des exonérations fréquentes résultant de pressions iléales élevées. Dans le but de développer une alternative aux techniques décrites cidessus, nous avons réalisé des anastomoses iléoanales directes complétées par deux myectomies (10 cmx1 cm) jusqu'à 2 cm au-dessus de la zone anastomotique. Ces deux myectomies sont situées à 120 degrés l'une de l'autre et à 120 degrés de l'insertion mésentérique de l'iléon. La justification de cette approche est d'obtenir une diminution de la péristaltique de l'iléon par affaiblissement de la paroi musculaire. Cette étude présente les résultats obtenus chez trois patients, opérés selon cette technique au cours de la dernière année.
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Landi, E., Landa, L., Fianchini, A. et al. Straight ileo-anal anastomosis with myectomy as an alternative to ileal pouch-anal anastomosis in restorative proctocolectomy. Int J Colorect Dis 9, 45–49 (1994). https://doi.org/10.1007/BF00304300
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DOI: https://doi.org/10.1007/BF00304300