Summary: | Colectomy, mucosal proctectomy and ileal pouch-anal anastomosis,
has become the procedure of choice for carefully selected patients with
ulcerative colitis requiring surgery. Pathophysiological studies after the operation
have led to a better understanding of the mechanisms of continence and to the
development of new technology to study anorectal function. Manometric studies
of the anal sphincter, ileal pouch and distal ileum have shown that the operation
alters the mechanisms of continence. The maximal tolerable volume of distension
of an ileal pouch often approximates that of a normal rectum and yet the
functional outcome may differ from a well functioning ileorectal anastomosis.
Many other factors influence the result of the operation. The influence of the
pattern of motility of the proximal and distal small bowel has been evaluated.
The ileal pouch accommodation to distension has been correlated to clinical
outcome. Scintigraphic techniques were designed to study the relationship
between motility, filling and emptying of the ileal reservoirs. Measures designed
to slow intestinal transit, increase absorption and reduce stool output are under
investigation.
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