Update on ileal pouch-anal anastomosis.
BACKGROUND
The surgical management of chronic ulcerative colitis and familial adenomatous polyposis was revolutionized in 1978 by the introduction of the ileal pouch-anal anastomosis, following proctolectomy and avoiding the necessity of a permanent stoma.


OBJECTIVE
To analyze the current status of ileal pouch-anal anastomosis.


METHODS
Factors such as age, concurrent medical conditions, and most importantly anal sphincter function are to be considered. Many technical aspects are reviewed such pouch design, mucosectomy, alternatives to perform the anastomosis, the use of diverting ileostomy, reservoir function and morbidity.


RESULTS
Patient selection is of paramount importance to achieve good results. Many modifications to pouch design have been made in an attempt to improve functional results. Shorter mucosectomy is performed with hand-sutured anastomosis and double stapled anastomosis are the surgical alternatives to restore intestinal continuity. The use of diverting ileostomy is recommended in most patients to prevent pelvic sepsis. Mortality following ileal pouch-anal anastomosis is extremely unusual, however, morbidity is moderate. Small bowel obstruction, pelvic sepsis, fistula formation and pouchitis are the most common complications. Sexual dysfunction represents a major concern for younger patients in need of this kind of surgical treatment. However, its occurrence is rare.


CONCLUSIONS
The ileal anal-pouch anastomosis has become the surgical treatment of choice for patients suffering from chronic ulcerative colitis and familial adenomatous polyposis. Primary advantages offered by this technique are that the disease is removed completely and adequate reservoir is restored and transanal defecation and fecal continence are reestablished, avoiding the necessity of a permanent stoma.
Moreno
E F
EF
Division of Colon & Rectal Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Domínguez
J M
JM
Sagar
P M
PM
Pemberton
J H
JH
D011125:Adenomatous Polyposis Coli / Q000601:surgery; D003093:Colitis, Ulcerative / Q000601:surgery; D005069:Evaluation Studies as Topic; D006801:Humans; D007081:Ileostomy; D018579:Patient Selection; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative / Q000009:adverse effects / Q000379:methods