Anal sphincteroplasty after restorativeproctocolectomy for ulcerative colitis in patients with anal sphincter defect: report of two cases: P026

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Aim:Ileal pouch-anal anastomosis (IPAA) is a standardized operation for patients with ulcerative colitis (UC). Since this operation is associated with varying degree of incontinence, an intact anal sphincter is essential. Does sphincteroplasty help?Method:We report two cases of IPAA performed for intractable UC withpre-existing sphincter injury treated by sphincteroplasty.Results:Case 1: 48-year-old with a 4th degree laceration from a vaginal delivery 18 yearspreviously. Nine months after IPAA, sphincteroplasty with perineoplasty was performed, and the ileostomy closed 3 months later. After 9 years' f/u, her Wexner score was eight, maximum restingpressure (MRP) 38 mmHg, and maximum squeezepressure (MSP) 75 mmHg. Case 2: A 43-year-old woman had anterior sphincter afterprevious rectovaginal fistula operation 7 years ago. Ten months after IPAA, she underwent sphincteroplasty with Z-plasty of the perineum before closure of diverting loop ileostomy. At 9 year F/U, her Wexner score was four, and MRP and MSP, 56.9 mmHg and 103.4 mmHg respectively. Both patients were satisfied with the results of operation.Conclusion:Our experience with two patients suggests that anal sphincteroplasty after IPAA is feasible in UC patients withpre-existing or postoperative sphincter defect, and that long-term satisfaction can be achieved.

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