title: Restorative proctocolectomy with a handsewn IPAA: S-pouch or J-pouch?
abstract: BACKGROUND
  The efferent limb on the S-pouch fits well into the anal canal while the body of the pouch lies on the levators. In contrast, the blunt end of a J-pouch may be distorted as it is forced into the muscular tube of the stripped anus.
  
  
  OBJECTIVE
  The aim of this study is to compare the clinical outcomes and quality of life between patients with S- and J-pouches with a handsewn IPAA.
  
  
  METHODS
  This study was retrospective.
  
  
  METHODS
  This study was conducted at a high-volume tertiary referral center.
  
  
  METHODS
  Patients undergoing a primary handsewn IPAA from 1983 to 2012 were identified.
  
  
  METHODS
  Demographics, operative details, functional outcomes, and quality of life were abstracted.
  
  
  RESULTS
  A total of 502 patients, including 169 patients with an S-pouch (33.7%) and 333 patients with J-pouch (66.3%), met our inclusion criteria; 55.8% (n = 280) were men. Mean age at pouch construction was 37.8 ± 12.5 years. Patients with an S-pouch were younger (p = 0.004) and had a higher BMI (p = 0.035) at pouch surgery. There was no significant difference between patients with S- or J-pouches in other demographics. The frequencies of short-term complications in the 2 groups were similar (p > 0.05), but pouch fistula or sinus (p = 0.047), pelvic sepsis (p = 0.044), postoperative partial small-bowel obstruction (p = 0.003), or postoperative pouch-related hospitalization (p = 0.021) occurred in fewer patients with an S-pouch. At a median follow-up of 12.2 (range, 4.3-20.1) years, patients with an S-pouch were found to have fewer bowel movements (p < 0.001), less frequent pad use (p = 0.001), and a lower fecal incontinence severity index score (p = 0.015). The pouch failed in 62 patients (12.4%), but neither univariate nor multivariate analysis showed a significant association with pouch configuration.
  
  
  CONCLUSIONS
  The use of data from a single tertiary referral center was a limitation of this study.
  
  
  CONCLUSIONS
  We recommend using an S-pouch when constructing an IPAA with a handsewn technique.
authors.affiliation: Department of Colorectal Surgery, the Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Xian-Rui
authors.initials: XR
authors.lastname: Wu
authors.forename: Hasan T
authors.initials: HT
authors.lastname: Kirat
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Kalady
authors.forename: James M
authors.initials: JM
authors.lastname: Church
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods*; D015331:Cohort Studies; D039021:Colonic Pouches; D005242:Fecal Incontinence; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative / Q000379:methods*; D011788:Quality of Life; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome