Abstract
PURPOSE: To clarify neurologic function with respect to external anal sphincter and puborectalis muscles after J configuration ileal J-pouch-anal anastomosis for patients with ulcerative colitis and adenomatosis coli, we examined the terminal motor latency in the pudendal and sacral motor nerve (S2-4). METHODS: Latency of the response in the external anal sphincter muscle following digitally directed transrectal pudendal nerve stimulation (PNTML) and in the puborectalis muscle following transcutaneous magnetic stimulation of the cauda equina at the levels S2-4 (SMNLTSS) were measured in 12 patients with ileal J-pouchanal anastomosis; they were divided into a group with continence (7 cases) and a group with soiling (5 cases). Results were compared with data obtained from 12 patients before operation and 15 controls. RESULTS: Conduction delay of PNTML and SMNLTSS in patients with soiling was longest, followed by delay in those without any soiling, then delay in patients before operation, and then controls. In addition, significant differences were also noted between conduction delay of PNTML in controls and those who are incontinent and experience soiling (P < 0.05 and P < 0.01, respectively), and there were significant differences also noted between conduction delay of PNTML in patients before operation and those who are incontinent and experiencing soiling (P < 0.05 and P < 0.01, respectively). Conduction delay of PNTML and SMNLTSS were found in patients before operation rather than in controls. No significant differences were noted between conduction delay of PNTML and SMNLTSS in patients before operation and controls. Significant differences were also noted between conduction delay of PNTML and SMNLTSS in patients who are incontinent and experiencing soiling (P < 0.01, respectively). CONCLUSION: These findings support the hypothesis that soiling after this procedure may be partially caused by damage to pudendal and sacral motor nerves (S2-4).
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Ravitch MM, Sabitson DC. Anal ileostomy with preservation of sphincter: a proposed operation in patients requiring total colectomy for benign lesions. Surg Gynecol Obstet 1947;84:1095–9.
Peck DA. Rectal mucosal replacement. Ann Surg 1980;191:294–304.
Utunomiya J, Iwama T, Imajo M,et al. Total colectomy, mucosal protectomy and ileoanal anastomosis. Dis Colon Rectum 1980;23:459–66.
Hepell J, Kelly KA, Phillips SF, Beart RW, Telander RL, Perraut JP. Physiologic aspects of continence after colectomy, mucosal proctectomy, and endorectal ileoanal anastomosis. Ann Surg 1982;195:435–43.
Kurosu Y. Total colectomy, mucosal proctectomy and ileo-anal anastomosis with ileal reservoir for ulcerative colitis and familial polyposis. Nihon Univ J Med 1989;31:207–15.
Becker JM. Ileal pouch-anal anastomosis: current status and controversies. Surg 1993;113:599–602.
Grant D, Cohen Z, McHugh S, McLeod R, Stern H. Restorative proctectomy, clinical results and manometric findings with long and short rectal cuff. Dis Colon Rectum 1986;29:27–32.
RonanO'Connel P, Stryker SJ, Metcaf AM, Pemberton JH, Kelly KA. Anal canal pressure and motility after ileoanal anastomosis. Surg Gynecol Obstet 1988;166:47–54.
Taylor BM, Cranley BC, Kelly KA, Phillips SF, Beart RW, Dozois RR. A clinico-physiological comparison of ileal pouch-anal and straight ileoanal anastomosis. Ann Surg 1983;198:462–8.
Stryker SJ, Phillips SD, Kelly KA. Anal and neorectal function after ileal pouch-anal anastomosis. Ann Surg 1986;203:55–61.
Hatakeyama K, Shimamura K, Muto T, Yamai K. Defecating function after ileal W pouch-anal anastomosis for restorative proctocolectomy: an evaluation by age. Acta Med Biol 1991;39:181–4.
Pembert JH. Neorectum and assessment of anorectal function following surgery. In: Kumar D, Waldron DJ, Williams NS, eds. Clinical measurement in coloproctology. London: Springer-Verlag, 1991:165–88.
Levitt MD, Kamm MA, Groom J, Hawley PR, Nicholls RJ. Ileoanal pouch compliance and motor function. Br J Surg 1992;79:126–8.
Tjandra JJ, Fazio VW, Church JM, Oakley JR, Milson JW, Lavery IC. Similar function results after restorative proctocolectomy in patients with familial adenomatous polyposis and mucosal ulcerative colitis. Am Surg 1993;165:322–5.
Cemlo BT, Wong WD, Rothenberger DA, Goldberg SM. Ileal pouch-anal anastomosis: patterns of failure. Arch Surg 1992;127:784–7.
Tomita R, Kurosu Y, Isozumi M, Tanjoh K, Munakata K. A pathophysiological study using manometry on patients with soiling after ileal J pouch-anal anastomosis (in Japanese with English abstract). Jpn J Gastroenterol Surg 1994;27:2551–6.
Read NW, Sun WM. Anorectal manometry, anal myography and rectal sensory testing. In: Read NW, eds. Gastrointestinal motility: which test? Petersfield: Wrightson Biomedical, 1989:227–41.
Kiff ES, Swash M. Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinence. Br J Surg 1984;71:614–6.
Kiff ES, Swash M. Normal proximal and delayed distal conduction in the pudendal nerves of patients with idiopathic (neurological) faecal incontinence. J Neurol Neurosurg Psychiatry 1984;47:820–3.
Gemlo BT, Wong WD, Rothenberger DA, Goldberg SM. Ileal pouch-anal anastomosis. Arch Surg 1992;127:784–7.
Wald A. Anorectum. In: Schuster MM, ed. Atras of gastrointestinal motility in healthy and disease. Baltimore: William and Wilkins, 1993:229–49.
Author information
Authors and Affiliations
Additional information
Read at the meeting of The Japan Society of Coloproctology, Kobe, Japan, September 24 to 26, 1994.
About this article
Cite this article
Tomita, R., Kurosu, Y. & Munakata, K. Electrophysiologic assessments in pudendal and sacral motor nerves after ileal J-pouch-anal anastomosis for patients with ulcerative colitis and adenomatosis coli. Dis Colon Rectum 39, 410–415 (1996). https://doi.org/10.1007/BF02054056
Issue Date:
DOI: https://doi.org/10.1007/BF02054056