title: [Differential indications for ileoanal pouch anastomosis : Ulcerative colitis, familial adenomatous polyposis, synchronous colorectal cancer - Crohn's disease, constipation].
abstract: Ileoanal pouch anastomosis is the procedure of choice for patients with drug refractory ulcerative colitis, indeterminate colitis and familial adenomatous polyposis (FAP). In selected patient groups this procedure is a treatment option for patients with Crohn's disease, hereditary nonpolyposis colorectal cancer (HNPCC), synchronous colorectal cancer and for severe colorectal constipation refractory to conservative drug treatment. The pouch procedure provides the opportunity to avoid a permanent ileostomy. The majority of surgeons prefer the ileal J‑pouch as the construction is the easiest to perform and complications and dysfunction rates are low. Due to functional reasons most pouch surgeons favor a circular stapled ileoanal pouch anastomosis. The more radical proctocolectomy can produce sensory defects in the anal canal with subsequent soiling and incontinence. Studies have shown that even after proctocolectomy residual rectal mucosa was found in the anal canal. Therefore, the functionally important anorectal transitional zone should be preserved if possible. Ulcerative colitis can be "healed" with proctocolectomy; however, pouchitis can still occur in one third of the patients. Patients must be informed about the risk of pouchitis and a multidisciplinary monitoring and treatment strategy must be available. In Crohn's disease the ileoanal pouch survival rate of 80% in the long-term follow-up is surprisingly good despite an increased postoperative complication rate. The anal pouch anastomosis is the standard operation in patients with drug refractory ulcerative colitis, indeterminate colitis and FAP. Synchronous colorectal cancer, HNPCC and severe therapy refractive constipation represent rare indications for proctocolectomy where decisions must be made on an individual basis.
authors.affiliation: Klinik für Allgemein-, Viszeral-, Thoraxchirurgie, Adipositasmedizin, Caritas-Krankenhaus St. Josef, Landshuterstr. 65, 93052, Regensburg, Deutschland. afuerst@caritasstjosef.de.
authors.forename: A
authors.initials: A
authors.lastname: Fürst
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000401:mortality / Q000601:surgery; D002908:Chronic Disease; D003092:Colitis / Q000401:mortality / Q000601:surgery; D003093:Colitis, Ulcerative / Q000401:mortality / Q000601:surgery; D003108:Colonic Diseases / Q000401:mortality / Q000601:surgery*; D039021:Colonic Pouches; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000401:mortality / Q000601:surgery; D003248:Constipation / Q000601:surgery; D003424:Crohn Disease / Q000401:mortality / Q000601:surgery; D008531:Megacolon / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012086:Reoperation; D015996:Survival Rate
keywords: Hereditary nonpolyposis colorectal cancer; Idiopathic megacolon; Ileoanal pouch anastomosis; Indeterminate colitis; Proctocolectomy