Stapled Mucosectomy: An Alternative Technique for the Removal of Retained Rectal Mucosa after Ileal Pouch-Anal Anastomosis
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Restorative proctocolectomy (RPC), when performed with a stapled ileal pouch-anal anastomosis (IPAA), allows the retention of the rectal mucosa above the dentate line and can result in disease persistence or recurrence, as well as neoplastic lesions in patients with ulcerative colitis (UC). We report the case of a patient with chronic UC who underwent staple mucosectomy, which is an alternative technique that evolved from stapled hemorrhoidopexy, rather than more traditional procedures. The patient had undergone laparoscopic RPC with a stapled IPAA 2 cm above the dentate line and a temporary loop ileostomy. Because the histopathology showed low-grade dysplasia in the proximal rectum, stapled mucosectomy with a 33-mm circular stapler kit at the time of ileostomy closure was scheduled. Following the application of a purse-string suture 1 cm above the dentate line, the stapler was inserted with its anvil beyond the purse-string and was fi red. The excised rectal tissue was checked to ensure that it was a complete cylindrical doughnut. Histopathology of the excised tissue showed chronic inflammation. There were no complications during a follow-up period of 5 months. Because it preserves the normal rectal mucosal architecture and avoids a complex mucosectomy surgery, stapled mucosectomy seems to be a technically feasible and clinically acceptable alternative to the removal of rectal mucosa retained after RPC.
Abstract
Restorative proctocolectomy (RPC), when performed with a stapled ileal pouch-anal anastomosis (IPAA), allows the retention of the rectal mucosa above the dentate line and can result in disease persistence or recurrence, as well as neoplastic lesions in patients with ulcerative colitis (UC). We report the case of a patient with chronic UC who underwent staple mucosectomy, which is an alternative technique that evolved from stapled hemorrhoidopexy, rather than more traditional procedures. The patient had undergone laparoscopic RPC with a stapled IPAA 2 cm above the dentate line and a temporary loop ileostomy. Because the histopathology showed low-grade dysplasia in the proximal rectum, stapled mucosectomy with a 33-mm circular stapler kit at the time of ileostomy closure was scheduled. Following the application of a purse-string suture 1 cm above the dentate line, the stapler was inserted with its anvil beyond the purse-string and was fi red. The excised rectal tissue was checked to ensure that it was a complete cylindrical doughnut. Histopathology of the excised tissue showed chronic inflammation. There were no complications during a follow-up period of 5 months. Because it preserves the normal rectal mucosal architecture and avoids a complex mucosectomy surgery, stapled mucosectomy seems to be a technically feasible and clinically acceptable alternative to the removal of rectal mucosa retained after RPC.
참고문헌 (14)
- Lovegrove RE, "A comparison of hand-sewn versus stapled ileal pouch anal anastomosis (IPAA) following proctocolectomy: a meta-analysis of 4183 patients", Ann Surg, 244, pp.18~26 (2006)
- Holder-Murray J, "Anal transition zone in the surgical management of ulcerative colitis", World J Gastroenterol, 15, pp.769~773 (2009)
- Remzi FH, "Dysplasia of the anal transitional zone after ileal pouch-anal anastomosis: results of prospective evaluation after a minimum of ten years", Dis Colon Rectum, 46, pp.6~13 (2003)
- Branco BC, "Adenocarcinoma following ileal pouch-anal anastomosis for ulcerative colitis: review of 26 cases", Inflamm Bowel Dis, 15, pp.295~299 (2009)
- Fujiwara T, "Endorectal ileal pullthrough procedure after chemical debridement of the rectal mucosa", Surg Gynecol Obstet, 158, pp.437~442 (1984)
- Heimann TM, "Ultrasonic mucosal proctectomy in patients with ulcerative colitis", Ann Surg, 210, pp.787~791 (1989)
- Kusunoki M, "Transanal mucosectomy using an ultrasonically activated scalpel for ulcerative colitis", Surg Today, 29, pp.392~394 (1999)
- Forshaw MJ, "Endoscopic transanal rectal mucosal ablation in the surgical treatment of ulcerative colitis: preliminary results of a novel technique", Dis Colon Rectum, 48, pp.1269~1274 (2005)
- Fazio VW, "Transanal mucosectomy. Ileal pouch advancement for anorectal dysplasia or inflammation after restorative proctocolectomy", Dis Colon Rectum, 37, pp.1008~1011 (1994)
- Litzendorf ME, "Completion mucosectomy for retained rectal mucosa following restorative proctocolectomy with double-stapled ileal pouch-anal anastomosis", J Gastrointest Surg, 14, pp.562~569 (2010)
- Branco BC, "Adenocarcinoma complicating restorative proctocolectomy for ulcerative colitis with mucosectomy performed by Cavitron Ultrasonic Surgical Aspirator", Colorectal Dis, 11, pp.428~429 (2009)
- Longo A, "Treatment of hemorrhoidal disease by reduction of mucosa and hemorrhoidal prolapse with circular suturing device: a new procedure. In: Proceedings of the 6th World Congress of Endoscopic Surgery", pp.777~784 (1998), Monduzzi Publishing Co
- Uras C, "Circular stapled hemorrhoidopexy: experience of a single center with 445 cases", World J Surg, 32, pp.1783~1788 (2008)
- Sileri P, "Stapled hemorrhoidopexy: a prospective study from pathology to clinical outcome", J Gastrointest Surg, 11, pp.1662~1668 (2007)