title: Controversies in J Pouch Surgery for Ulcerative Colitis: A Focus on Handsewn Versus Stapled Anastomosis.
abstract: The accepted current standard for treatment of medically refractory ulcerative colitis is total proctocolectomy with an ileal pouch-anal anastomosis for restoration of continence. There are 2 techniques by which the anastomosis can be performed, including handsewn and stapled. Handsewn anastomosis with mucosectomy was the first method described; however, it has been associated with significant incontinence. The double-stapled anastomosis was developed in response to improve postoperative function. Controversy remains as to which technique is superior as both have disadvantages. This review article addresses differences between the 2 methodologies in relation to postoperative complications, anorectal physiology, functional outcomes, and oncological safety.
authors.affiliation: Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Tamar
authors.initials: T
authors.lastname: Nobel
authors.forename: Sergey
authors.initials: S
authors.lastname: Khaitov
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Greenstein
mesh_terms: D001003:Anal Canal / Q000503:physiopathology; D000714:Anastomosis, Surgical / Q000379:methods*; D003093:Colitis, Ulcerative / Q000473:pathology / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology; D019449:Pouchitis / Q000209:etiology; D011230:Precancerous Conditions / Q000473:pathology; D016737:Proctocolectomy, Restorative / Q000009:adverse effects / Q000379:methods*; D018805:Sepsis / Q000209:etiology