Bowel habit and other functional outcomes are thought by many to be better preserved and more physiological with IRA as compared to IPAA [20,21]. Restorative proctocolectomy with mucosectomy and hand-sewn IPAA is thought to carry a relatively higher risk of postoperative functional impairment and incontinence due to increased manipulation of the anal canal . Stapled IPAA, on the other hand, results in preservation of the anal transition zone mucosa 1-2 cm above the dentate line, which is thought to be important in the control of continence. This has been shown by many to result in better functional outcome and quality of life after IPAA [13,19, 22]. In the case of IPAA, it has been suggested that functional outcome is poorer in patients with ulcera-tive colitis (UC) than those with FAP . It has also been suggested that secondary IPAA, often performed following failed IRA (due to rectal cancer or poor functional outcome), is associated with poorer bowel function than a primary IPAA procedure .
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