Intraoperative, postoperative and reoperative problems with ileoanal pouches.
BACKGROUND
Proctocolectomy with ileal pouch-anal anastomosis (IPAA) has been developed and refined since its introduction in the late 1970s. Nonetheless, it is a procedure associated with significant morbidity. The aim of this review was to provide a structured approach to the challenges that surgeons and physicians encounter in the management of intraoperative, postoperative and reoperative problems associated with ileoanal pouches.


METHODS
The review was based on relevant studies identified from an electronic search of MEDLINE, Embase and PubMed databases from 1975 to April 2011. There were no language or publication year restrictions. Original references in published articles were reviewed.


RESULTS
Although the majority of patients experience long-term success with an ileoanal pouch, significant morbidity surrounds IPAA. Surgical intervention is often critical to achieve optimal control of the situation.


CONCLUSIONS
A structured management plan will minimize the adverse consequences of the problems associated with pouches.
John Goligher Department of Colorectal Surgery, General Infirmary at Leeds, Leeds, UK. petersagar@aol.com
P M
PM
Sagar
J H
JH
Pemberton
D018784:Abdominal Abscess / Q000209:etiology / Q000601:surgery; D000714:Anastomosis, Surgical / Q000379:methods; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D003424:Crohn Disease / Q000175:diagnosis; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery; D057210:Delayed Diagnosis; D004106:Dilatation / Q000379:methods; D004322:Drainage / Q000379:methods; D005260:Female; D018222:Desmoid Tumors; D005770:Gastrointestinal Neoplasms / Q000209:etiology / Q000601:surgery; D006801:Humans; D007081:Ileostomy / Q000379:methods; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery; D007421:Intestine, Small; D007431:Intraoperative Complications / Q000209:etiology* / Q000517:prevention & control; D010535:Laparoscopy / Q000379:methods; D011169:Portal Vein; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D019449:Pouchitis / Q000209:etiology / Q000601:surgery; D011349:Proctitis / Q000209:etiology / Q000601:surgery; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012086:Reoperation / Q000379:methods; D016879:Salvage Therapy / Q000379:methods; D017792:Surgical Stapling / Q000379:methods; D014624:Vaginal Fistula / Q000209:etiology / Q000601:surgery; D020246:Venous Thrombosis / Q000209:etiology* / Q000601:surgery; D014782:Visceral Prolapse / Q000209:etiology / Q000601:surgery