Anal transitional zone and columnar cuff in restorative proctocolectomy

Br J Surg. 1996 Aug;83(8):1047-55. doi: 10.1002/bjs.1800830806.


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.

Publication types

  • Review

MeSH terms

  • Anal Canal / pathology*
  • Anus Diseases / surgery*
  • Biopsy, Needle
  • Colitis, Ulcerative / pathology
  • Colitis, Ulcerative / surgery
  • Humans
  • Proctocolectomy, Restorative / methods*
  • Surgical Stapling