Ileal pouch-anal anastomosis.
BACKGROUND
Since 1977, restorative proctocolectomy with ileoanal anastomosis (IAA) has evolved into the surgical treatment of choice for most patients with intractable ulcerative colitis. Construction of an ileal pouch reservoir is now standard, usually in the form of J pouch (IPAA). The aim of this report is to review selection criteria for, and functional outcomes, follow-up and management of complications of IPAA after 30 years of widespread clinical application.


RESULTS
Literature published in English on the clinical indications, surgical technique, morbidity, complications and outcome following IAA and IPAA was sourced by electronic search, performed independently by two reviewers who selected potentially relevant papers based on title and abstract. Additional articles were identified by cross-referencing from papers retrieved in the initial search.


CONCLUSIONS
The functional results of IPAA are good. Pouchitis, irritable pouch syndrome and cuffitis are specific long-term complications but rarely result in failure. Pouch salvage is possible in selected patients with poor functional outcomes. One-stage operations are increasingly performed.
McGuire
B B
BB
Department of Colorectal Surgery, Mater Misericordiae University Hospital and School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
Brannigan
A E
AE
O'Connell
P R
PR
D011125:Adenomatous Polyposis Coli / Q000601:surgery; D000714:Anastomosis, Surgical / Q000379:methods; D003093:Colitis, Ulcerative / Q000601:surgery; D039021:Colonic Pouches; D003672:Defecation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019449:Pouchitis / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology; D011788:Quality of Life; D012735:Sexual Dysfunction, Physiological / Q000209:etiology