title: Ileal pouch-anal anastomosis: Points of controversy.
abstract: Restorative proctocolectomy with ileal pouch-anal anastomosis has become the most commonly used procedure for elective treatment of patients with ulcerative colitis and familial adenomatous polyposis. Since its original description, the procedure has been modified in order to obtain optimal functional results with low morbidity and mortality, and yet provide a cure for the disease. In this review of the literature of restorative proctocolectomy with ileal pouch-anal anastomosis, we discuss these technical modifications, limiting our discussion to the current points of controversy. The current "hot topics" for debate are: indications for ileal pouch-anal or ileo-rectal anastomosis, indications for pouch surgery in the elderly, indeterminate colitis and Crohn's disease, the place of the laparoscopic approach, transanal mucosectomy with hand-sewn anastomosis vs. the double-stapled technique, the use of diverting ileostomy and the issue of the best route for delivery of pregnant women. Longer follow-up of patients and increased knowledge and experience with pouch surgery, coupled with ongoing prospective evaluation of the procedure are required to settle these issues.
authors.affiliation: Department of general and digestive surgery, Habib Bourguiba Teaching Hospital, 3029 Sfax, Tunisia. Electronic address: aymen.trigui@yahoo.fr.
authors.forename: A
authors.initials: A
authors.lastname: Trigui
authors.affiliation: Department of general and digestive surgery, Habib Bourguiba Teaching Hospital, 3029 Sfax, Tunisia.
authors.forename: F
authors.initials: F
authors.lastname: Frikha
authors.affiliation: Department of general and digestive surgery, Habib Bourguiba Teaching Hospital, 3029 Sfax, Tunisia.
authors.forename: H
authors.initials: H
authors.lastname: Rejab
authors.affiliation: Department of general and digestive surgery, Habib Bourguiba Teaching Hospital, 3029 Sfax, Tunisia.
authors.forename: H
authors.initials: H
authors.lastname: Ben Ameur
authors.affiliation: Department of general and digestive surgery, Habib Bourguiba Teaching Hospital, 3029 Sfax, Tunisia.
authors.forename: H
authors.initials: H
authors.lastname: Triki
authors.affiliation: Department of general and digestive surgery, Habib Bourguiba Teaching Hospital, 3029 Sfax, Tunisia.
authors.forename: M
authors.initials: M
authors.lastname: Ben Amar
authors.affiliation: Department of general and digestive surgery, Habib Bourguiba Teaching Hospital, 3029 Sfax, Tunisia.
authors.forename: R
authors.initials: R
authors.lastname: Mzali
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000175:diagnosis / Q000601:surgery*; D000368:Aged; D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical / Q000379:methods; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000601:surgery*; D039021:Colonic Pouches; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D008297:Male; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011247:Pregnancy; D016737:Proctocolectomy, Restorative / Q000009:adverse effects / Q000379:methods*; D011379:Prognosis; D011786:Quality Control; D018570:Risk Assessment; D017792:Surgical Stapling / Q000379:methods; D016896:Treatment Outcome
keywords: Crohn's disease; Familial adenomatous polyposis; Ileal pouch anal anastomosis; Indeterminate colitis; Ulcerative colitis