title: Problems after restorative proctocolectomy: assessment and therapy.
abstract: OBJECTIVE
  Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice for patients with ulcerative colitis or familial adenomatous polyposis who require colectomy. Although the surgical procedure significantly improves the patients' quality of life, complications are common. Mechanical or structural complications related to surgical techniques as well as chronic pouchitis are common after the procedure.
  
  
  RESULTS
  Recent literature has suggested some of those mechanical complications, along with chronic pouchitis, may share similar risk factors, particularly between anastomotic leak or sinus and chronic pouchitis. Those factors include male gender, obesity, weight gain, and Clostridium difficile infection.
  
  
  CONCLUSIONS
  Mounting clinical evidence suggests that ischemia or excessive fat deposition plays an important role in the development of the surgical procedure-associated mechanical complication as well as chronic antibiotic-refractory pouchitis. Those findings along with the theory of ischemia/fat deposition will shed some light on the pathogenesis of the complex pouch disorders, providing the guidance for the risk stratification, prevention, diagnosis, and management.
authors.affiliation: Interventional IBD Unit (i-IBD), Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000503:physiopathology / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003015:Clostridium Infections / Q000188:drug therapy / Q000209:etiology*; D003093:Colitis, Ulcerative / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications; D019449:Pouchitis / Q000209:etiology* / Q000628:therapy; D015995:Prevalence; D016737:Proctocolectomy, Restorative / Q000009:adverse effects; D011788:Quality of Life; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents