Approximately 8 weeks after the
IPAA is completed, anal manometry is repeated to ensure that the anal sphincter
muscles have retained full function. The volume of the ileal pouch is also
measured. Pending the satisfactory outcome of these tests, the loop ileostomy
is then closed using a stapling technique, which has greatly simplified this operation.
A transverse elliptical incision is made in the skin around the site of the
loop ileostomy. The loop is then dissected free from the subcutaneous tissue
and the fascia. The afferent and efferent limbs are divided with a stapling
device. A side-to-side functional end-to-end anastomosis is then created
between the two limbs with a 75-mm anastomosing stapler. The enterotomy is
closed with a 60-mm linear stapler. The anastomosed loops of ileum are then
placed back into the peritoneal cavity, and the fascia, subcutaneous tissue,
and skin are closed. The standard protocol at this center requires that
patients are followed at approximately 1 month, 3 months, 6 months, and 12
months after closure of the loop ileostomy and then are seen at yearly
intervals for follow-up. Anorectal manometry is repeated at 1 year.
Unless subsequent long-term
complications such as pouchitis arise,
patients generally undergo flexible fiberoptic pouchoscopy with surveillance
biopsies of the ileal pouch approximately every 5 years.
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Ref: Maingot’s 11th
ed
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