“Small is beautiful” A series of ileo-anal anastomoses performed with the 25 – mm circular stapler


COD: 02_2016_1228_2491 Categorie: ,

Andrea Resegotti, Stefano Silvestri, Marco Astegiano, Giacomo Deiro, Davide Ribaldone, Davide Cassine, Alessandro Franchello

Ann. Ital. Chir., 2016 87: 186-191

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AIM: With the idea that a small diameter stapler should cause less sphincter trauma, we began to use the 25mm circular
stapler to perform ileo-pouch-anal anastomosis (IPAA) and we report our experience.
MATERIAL OF STUDY: A retrospective study using a bowel function questionnaire and a quality of life questionnaire has
been conducted on a group of patients who underwent IPAA using a 25mm stapler
RESULTS: We performed IPAA using a 25mm circular stapler in 37 patients. Postoperative mortality was nil and morbidity
was 27%. One anastomotic stenosis occurred. Long term follow-up information was available on 28 patients.
Mean follow-up was 70 months (range 8-177). Mean number of bowel movements was 4.5 (range 2-10, median 4.5)
during the day and 0.9 (range 0-10, median 0) at night. Out of 28 patients, 19 (68%) were fully continent and
32% had occasional soiling, no one reported incontinence. All patients except one were able to withold their stool for
more than 15 minutes. Daytime pad use was: never 86%, occasionally 3%, frequently 11%; nightime pas use was never
86%, occasionally 7% and frequently 7%. Bowel regulating drugs use was never 82%, occasionally 14%, regularly 4%.
Evacuation difficulties were: never 75%, occasionally 21%, frequently 4%.
DISCUSSION: Our results compare favourably with the literature, which reports median bowel frequency 6-7.6/24h, 9.4-
33% urgency, 17-44% daytime soiling and 32-61% nighttime soiling.
CONCLUSIONS: Our results must be considered preliminary but we found the 25-mm stapler safe and adequate to perform