Mucosectomy with Hand Sewn Anastomosis or Double Stapling Technique

After performing mucosectomy and manual anastomosis, percentage of disorders pertaining fine tuning of continence is registered (such as spotting, daily and especially nightly soiling), which is definitely higher than the clinical situation after performing stapled anastomosis (30-50% vs about 10%) [10,11].

Stapled anastomosis entails less handling of the anal canal, reduced sphincterial trauma, lower anasto-motic tension and preservation of the transitional mucosa with a sensorial-discriminating function, which are all details to simplify the operation and improve functional results [12-14], as various retrospective and observational studies testify [6, 14, 15]. The different results appear to be less obvious if randomised studies only are taken into account [16-18]. Probably the heterogeneity of patients (including FAP cases), variability of the anastomosis level and methodological differences in the analysis of results may explain these discrepancies. Regardless, both from the Swedish [18] and Mayo Clinic [16] study, a trend showing a better night faecal continence emerges in patients with stapled anastomosis, which is a meaningful variable for patient overall well-being.

Manometric evaluations performed after IPAA show reduction in anal basal tone in comparison with preoperative values, but in all evaluations carried out, reduction of sphincterial tone is less obvious after a stapled suture [10,12,14-16,18]. Stapled anastomosis at the top of the anal canal preserves the anatomic functional integrity of the anal region whereas if performed at the dentated line, it causes damage to the internal sphincter and produces results similar to those of the manual technique [10, 11, 19]. Results of the stapled IPAA as a whole are functionally superior, as with the preservation of a suitable anal pressure gradient and transitional mucosa, which are important for the sampling [6,10, 13,14, 20]. Moreover, the stapled IPAA entails fewer septic complications and a lower risk of reservoir failure due to pelvic sepsis [6, 21, 22]. However, on these topics, unanimous agreement in the surgical community has not been reached [7,8,10,13,23,25].

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