Gut and Liver, Vol. 5, No. 4, December 2011, pp. 539-542 case report Stapled Mucosectomy: An Alternative Technique for the Removal of Retained Rectal Mucosa after Ileal Pouch-Anal Anastomosis Metin Ertem and Volkan Ozben Department of General Surgery, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey Restorative proctocolectomy (RPC), when performed with a stapled ileal pouch-anal anastomosis (IPAA), allows the retention of the rectal mucosa above the dentate line and can result in disease persistence or recurrence, as well as neoplastic lesions in patients with ulcerative colitis (UC). We report the case of a patient with chronic UC who underwent staple mucosectomy, which is an alternative technique that evolved from stapled hemorrhoidopexy, rather than more traditional procedures. The patient had undergone laparo- scopic RPC with a stapled IPAA 2 cm above the dentate line and a temporary loop ileostomy. Because the histopathology showed low-grade dysplasia in the proximal rectum, stapled mucosectomy with a 33-mm circular stapler kit at the time of ileostomy closure was scheduled. Following the application of a purse-string suture 1 cm above the dentate line, the sta- pler was inserted with its anvil beyond the purse-string and was ﬁred. The excised rectal tissue was checked to ensure that it was a complete cylindrical doughnut. Histopathology of the excised tissue showed chronic inflammation. There were no complications during a follow-up period of 5 months. Because it preserves the normal rectal mucosal architecture and avoids a complex mucosectomy surgery, stapled muco- sectomy seems to be a technically feasible and clinically ac- ceptable alternative to the removal of rectal mucosa retained after RPC. (Gut Liver 2011;5:539-542) Key Words: Ulcerative colitis; Retained rectal mucosa; Sta- pled mucosectomy; Surgical technique INTRODUCTION Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is now considered the procedure of choice for the surgical treatment of patients with ulcerative colitis (UC).1-3 The IPAA can be performed using either a stapling tech- nique or a handsewn technique with mucosectomy. Currently, double stapled IPAA is favoured as it is simpler and provides better functional results than the handsewn IPAA with muco- sectomy.1,3 On the other hand, the stapled technique allows the retention of 1 to 2 cm strip of the rectal and anal transition zone mucosa above the dentate line. Since UC is a mucosal disease, often originating in the rectum and progressing proximally, retention of the potentially diseased rectal mucosa exposes UC patients not only to chronic inflam- mation or disease recurrence but also to neoplastic lesions, as already reported.2,4 For this reason, a number of techniques have been proposed in order to eradicate the rectal mucosa,5-10 how- ever, these techniques harbor several disadvantages with respect to either technical aspects or histopathologic interpretation of the excised tissue. Here, we report on a case in order to intro- duce an alternative technique, stapled mucosectomy, for the removal of the rectal mucosa retained after previous RPC with stapled IPAA. CASE REPORT A 62-year-old male patient who had had a 7-year history of UC refractory to medical therapy underwent laparoscopic RPC with an ileal J-pouch, IPAA and temporary loop ileostomy in our institution. The J-pouch was created with the stapled tech- nique and the pouch was anastomozed approximately 2 cm above the dentate line using a 31-mm transanal circular stapler. Postoperatively, the patient was discharged home after an un- eventful recovery. The histopathology of the proctocolectomy specimen showed low grade dysplasia in the proximal rectum with no evidence of malignancy throughout the colon. Based on the result of the histolopathology, an elective surgery for a completion mucosectomy at the time of ileostomy closure was Correspondence to: Volkan Ozben Department of General Surgery, Cerrahpasa Medical School, Istanbul University, Surmene Devlet Hastanesi, Genel Cerrahi Klinigi, P.O. Box: 61600, Surmene, Trabzon, Turkey Tel: +90-462-746-1422, Fax: +90-462-746-1429, E-mail: volkanozben@yahoo.co.uk Received on June 17, 2010. Accepted on August 2, 2010. pISSN 1976-2283 eISSN 2005-1212 http://dx.doi.org/10.5009/gnl.2011.5.4.539 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.