Anal transitional zone and columnar cuff in restorative proctocolectomy
Article first published online: 6 DEC 2005
Copyright © 1996 British Journal of Surgery Society Ltd.
British Journal of Surgery
Volume 83, Issue 8, pages 1047–1055, August 1996
How to Cite
Thompson-Fawcett, M. W. and McC. Mortensen, N. J. (1996), Anal transitional zone and columnar cuff in restorative proctocolectomy. Br J Surg, 83: 1047–1055. doi: 10.1002/bjs.1800830806
- Issue published online: 6 DEC 2005
- Article first published online: 6 DEC 2005
- Manuscript Accepted: 19 MAR 1996
The popularity of double stapling the ileal pouch-anal anastomosis probably owes more to the technical ease it brings than to histological considerations or functional results. It is preservation of a ‘columnar cuff’ of mucosa, rather than the restricted site of the anal transitional zone, that should be the focus of research with respect to long-term risk of malignancy and inflammatory complications. If cancer is present in colon that has been removed for ulcerative colitis, there is a 25 per cent incidence of dysplasia in the columnar cuff in the short term. In other circumstances, those who are spared from carcinoma by colectomy are likely to have a similar risk of developing dysplastic change in the columnar cuff with longer follow-up. Double stapling the pouch-anal anastomosis and preserving the anal canal mucosa improves function, but long-term surveillance of the columnar cuff is then required, including biopsies.