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The Management of Patients with Dysplasia in the Anal Transitional Zone

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Mastery of IBD Surgery

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Abstract

Sir Alan Parks in 1978 described the first case series of proctocolectomy with ileal-pouch creation [1]. The purpose of the procedure was to remove all disease-prone mucosa in ulcerative colitis (UC) while maintaining intestinal continuity [1]. Of the two main surgical methods of forming ileal pouches, the double-stapled (DS) method may have advantages over the handsewn (HS) approach including lower postoperative complications and better functional outcomes [2]. However, an inherent limitation of this technique is the persistence of a length of anal transitional zone (ATZ), the area between colorectal type mucosa above and the squamous epithelium below [3]. Because this mucosa is at risk of chronic inflammation and dysplasia [3, 4], there is a long term risk of perianastomotic malignancy [5]. The management of pouch and ATZ dysplasia take two forms; minimizing the development of dysplasia and treating established dysplasia. To minimize dysplasia, the mucosa left after surgery must be minimized and ensuing inflammation avoided. The former may be achieved by performing a mucosectomy and a HS anastomosis and the latter by treating inflammation of the rectal cuff.

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Authors and Affiliations

  1. St. Mark’s Hospital, Harrow, UK

    Dakshitha Wickramasinghe MD(Surgery), DM MRCSEd & Janindra Warusavitarne B Med, FRACS, PhD

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  1. Dakshitha Wickramasinghe MD(Surgery), DM MRCSEd
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  2. Janindra Warusavitarne B Med, FRACS, PhD
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Correspondence to Janindra Warusavitarne B Med, FRACS, PhD .

Editor information

Editors and Affiliations

  1. Colon and Rectal Surgery, University of Chicago, Chicago, IL, USA

    Neil Hyman

  2. Section of Colon and Rectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Phillip Fleshner

  3. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Scott Strong

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Wickramasinghe, D., Warusavitarne, J. (2019). The Management of Patients with Dysplasia in the Anal Transitional Zone. In: Hyman, N., Fleshner, P., Strong, S. (eds) Mastery of IBD Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-16755-4_42

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  • DOI: https://doi.org/10.1007/978-3-030-16755-4_42

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-030-16755-4

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