Original articles Stenosis of the pouch anal anastomosis following restorative proctocolectomy

Purpose: To compare the incidence of stenosis after hand-sewn and stapled ileoanal anastomosis. Steno- sis of the ileoanal anastomosis occurs in 5-16% of patients undergoing a restorative proctocolectomy but the inci- dence using a stapled technique is unknown. Methods: Between 1976 and 1990, 266 patients underwent restora- tive proctocolectomy or proctectomy at one hospital. In two hundred and eighteen the anastomosis was hand sewn and stapled in 48 (single 33; double 15). Results: Steno- sis occurred in 31 (14.2%) of the hand-sewn and in 19 (39.6%) of the stapled anastomoses. This difference was highly significant (P< 0.001). Stenosis was not related to the size of the staple head used or to the stapling technique. There was no relationship between the development of stenosis and pelvic sepsis. Twenty six (hand-sewn 16, sta- pled 10) of the 48 patients with stenosis needed dilatation under general anaesthetic. Conclusion: Stapled anasto- moses may result in a high incidence of anastomotic sten- osis.