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World J Gastroenterol. Feb 21, 2009; 15(7): 769-773
Published online Feb 21, 2009. doi: 10.3748/wjg.15.769
Anal transition zone in the surgical management of ulcerative colitis
Jennifer Holder-Murray, Alessandro Fichera
Jennifer Holder-Murray, Alessandro Fichera, Department of Surgery, University of Chicago, Chicago, IL 60637, United States
Author contributions: Holder-Murray J and Fichera A wrote the paper.
Correspondence to: Alessandro Fichera, MD, Department of Surgery, University of Chicago, 5841 S. Maryland Ave MC 5095, Chicago, IL 60637, United States. afichera@surgery.bsd.uchicago.edu
Telephone: +1-773-7026142
Fax: +1-773-8341995
Received: October 21, 2008
Revised: January 20, 2009
Accepted: January 27, 2009
Published online: February 21, 2009

Preservation of the anal transition zone has long been a significant source of controversy in the surgical management of ulcerative colitis. The two techniques for restorative proctocolectomy and ileal pouch anal anastomosis (RPC IPAA) in common practice are a stapled anastomosis and a handsewn anastomosis; these techniques differ in the amount of remaining rectal mucosa and therefore the presence of the anal transition zone following surgery. Each technique has advantages and disadvantages in long-term functional outcomes, operative and postoperative complications, and risk of neoplasia. Therefore, we propose a selective approach to performing a stapled RPC IPAA based on the presence of dysplasia in the preoperative endoscopic evaluation.

Keywords: Anal transition zone, Ileal pouch anal anastomosis, Restorative proctocolectomy, Ulcerative colitis