Stapled mucosectomy: an alternative technique for the removal of retained rectal mucosa after ileal pouch-anal anastomosis.

Gut Liver. 2011 Dec; 5(4): 539-42
Ertem M, Ozben V

Restorative proctocolectomy (RPC), when performed with the stapled ileal pouch-anal anastomosis (IPAA), allows the retention of the rectal mucosa on top of the dentate line and can result in disease diligence or recurrence, as good as neoplastic lesions in patients with ulcerative colitis (UC). We report the case of the studious with chronic UC who underwent tack mucosectomy, which is an alternative technique that evolved from stapled hemorrhoidopexy, rsther than than more traditional procedures. The studious had undergone laparoscopic RPC with the stapled IPAA 2 cm on top of the dentate line and the proxy loop ileostomy. Because the histopathology showed low-grade dysplasia in the proximal rectum, stapled mucosectomy with the 33-mm circular stapler kit during the time of ileostomy closure was scheduled. Following the duplicate of the purse-string suture 1 cm on top of the dentate line, the stapler was inserted with the anvil beyond the purse-string and was fired. The excised rectal tissue was checked to ensure that it was the complete cylindrical doughnut. Histopathology of the excised tissue showed chronic inflammation. There were no complications during the follow-up period of 5 months. Because it preserves the normal rectal mucosal architecture and avoids the complex mucosectomy surgery, stapled mucosectomy seems to be the technically possibly and clinically acceptable alternative to the dismissal of rectal mucosa defended after RPC.

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