Ileal Pouch Surgery for Ulcerative Colitis

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2007 Jul 31

PMID 17659667

Citations 25

Authors

Simon P Bach

Neil J Mortensen

Affiliations

Soon will be listed here.

Abstract

Ulcerative colitis (UC) is a relapsing and remitting disease characterised by chronic mucosal and submucosal inflammation of the colon and rectum. Treatment may vary depending upon the extent and severity of inflammation. Broadly speaking medical treatments aim to induce and then maintain remission. Surgery is indicated for inflammatory disease that is refractory to medical treatment or in cases of neoplastic transformation. Approximately 25% of patients with UC ultimately require colectomy. Ileal pouch-anal anastomosis (IPAA) has become the standard of care for patients with ulcerative colitis who ultimately require colectomy. This review will examine indications for IPAA, patient selection, technical aspects of surgery, management of complications and long term outcome following this procedure.

Citing Articles

Assessing the Impact of Interval Duration Between Ileal Pouch Creation and Loop Ileostomy Closure on the Development of Subsequent Inflammatory Pouch Conditions in Patients with Ulcerative Colitis.

Zemanek M, Westbrook Cates K, Powers J, Dester E, Yang Q, Smith R Crohns Colitis 360. 2025; 7(1):otaf005.

PMID: 39901966 PMC: 11788594. DOI: 10.1093/crocol/otaf005.

Functional characterization of novel anti-DEFA5 monoclonal antibody clones 1A8 and 4F5 in inflammatory bowel disease colitis tissues.

Thangaiyan R, Sakwe A, Hawkins A, Washington M, Ballard B, Izban M Inflamm Res. 2025; 74(1):30.

PMID: 39883179 PMC: 11782311. DOI: 10.1007/s00011-024-01970-w.

Negative-Pressure Wound Therapy: A Novel Approach for Terminal Ileum Anastomosis Success.

Perez-Restrepo M, Moya-Ortiz C, Eslait-Olaciregui S, Baez-Lopez D, Paez N, Pineros Nieto D Am J Case Rep. 2025; 26():e945745.

PMID: 39754351 PMC: 11706434. DOI: 10.12659/AJCR.945745.

Emergent Subtotal Colectomies Have Higher Leak Rates in Subsequent J-Pouch Stages.

Plietz M, Coste M, Miller J, Kayal M, Chuquin K, Rizvi A J Gastrointest Surg. 2023; 27(4):760-765.

PMID: 36913174 DOI: 10.1007/s11605-023-05631-x.

Laparoscopic restorative proctocolectomy with ileal-J-pouch anal canal anastomosis without diverting ileostomy for total colonic and extensive aganglionosis is safe and feasible with combined Lugol's iodine staining technique and indocyanine green....

Nakagawa Y, Yokota K, Uchida H, Hinoki A, Shirota C, Tainaka T Front Pediatr. 2023; 10:1090336.

PMID: 36683800 PMC: 9853408. DOI: 10.3389/fped.2022.1090336.

References

Parks A, Nicholls R . Proctocolectomy without ileostomy for ulcerative colitis. Br Med J. 1978; 2(6130):85-8. PMC: 1605901. DOI: 10.1136/bmj.2.6130.85. View

de Silva H, De Angelis C, Soper N, Kettlewell M, Mortensen N, Jewell D . Clinical and functional outcome after restorative proctocolectomy. Br J Surg. 1991; 78(9):1039-44. DOI: 10.1002/bjs.1800780905. View

Rutter M, Saunders B, Wilkinson K, Rumbles S, Schofield G, Kamm M . Severity of inflammation is a risk factor for colorectal neoplasia in ulcerative colitis. Gastroenterology. 2004; 126(2):451-9. DOI: 10.1053/j.gastro.2003.11.010. View

Hallgren T, Fasth S, Oresland T, Hulten L . Ileal pouch anal function after endoanal mucosectomy and handsewn ileoanal anastomosis compared with stapled anastomosis without mucosectomy. Eur J Surg. 1995; 161(12):915-21. View

Delaney C, Remzi F, Gramlich T, Dadvand B, Fazio V . Equivalent function, quality of life and pouch survival rates after ileal pouch-anal anastomosis for indeterminate and ulcerative colitis. Ann Surg. 2002; 236(1):43-8. PMC: 1422547. DOI: 10.1097/00000658-200207000-00008. View

Eaden J, Abrams K, Mayberry J . The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut. 2001; 48(4):526-35. PMC: 1728259. DOI: 10.1136/gut.48.4.526. View

Luukkonen P, Jarvinen H . Stapled vs hand-sutured ileoanal anastomosis in restorative proctocolectomy. A prospective, randomized study. Arch Surg. 1993; 128(4):437-40. DOI: 10.1001/archsurg.1993.01420160075012. View

Hurst R, Molinari M, Chung T, Rubin M, Michelassi F . Prospective study of the incidence, timing and treatment of pouchitis in 104 consecutive patients after restorative proctocolectomy. Arch Surg. 1996; 131(5):497-500; discussion 501-2. DOI: 10.1001/archsurg.1996.01430170043007. View

Deutsch A, McLeod R, Cullen J, Cohen Z . Results of the pelvic-pouch procedure in patients with Crohn's disease. Dis Colon Rectum. 1991; 34(6):475-7. DOI: 10.1007/BF02049932. View

10.

Groisman G, George J, Harpaz N . Ulcerative appendicitis in universal and nonuniversal ulcerative colitis. Mod Pathol. 1994; 7(3):322-5. View

11.

Tuckson W, Lavery I, Fazio V, Oakley J, Church J, Milsom J . Manometric and functional comparison of ileal pouch anal anastomosis with and without anal manipulation. Am J Surg. 1991; 161(1):90-5; discussion 95-6. DOI: 10.1016/0002-9610(91)90366-l. View

12.

Hosie K, Grobler S, Keighley M . Temporary loop ileostomy following restorative proctocolectomy. Br J Surg. 1992; 79(1):33-4. DOI: 10.1002/bjs.1800790111. View

13.

Gionchetti P, Rizzello F, Helwig U, Venturi A, Lammers K, Brigidi P . Prophylaxis of pouchitis onset with probiotic therapy: a double-blind, placebo-controlled trial. Gastroenterology. 2003; 124(5):1202-9. DOI: 10.1016/s0016-5085(03)00171-9. View

14.

Tjandra J, Fazio V, Milsom J, Lavery I, Oakley J, Fabre J . Omission of temporary diversion in restorative proctocolectomy--is it safe?. Dis Colon Rectum. 1993; 36(11):1007-14. DOI: 10.1007/BF02047291. View

15.

Maartense S, Dunker M, Slors J, Cuesta M, Gouma D, van Deventer S . Hand-assisted laparoscopic versus open restorative proctocolectomy with ileal pouch anal anastomosis: a randomized trial. Ann Surg. 2004; 240(6):984-91. PMC: 1356514. DOI: 10.1097/01.sla.0000145923.03130.1c. View

16.

Remzi F, Gorgun E, Bast J, Schroeder T, Hammel J, Philipson E . Vaginal delivery after ileal pouch-anal anastomosis: a word of caution. Dis Colon Rectum. 2005; 48(9):1691-9. DOI: 10.1007/s10350-005-0124-7. View

17.

Thompson-Fawcett M, Warren B, Mortensen N . A new look at the anal transitional zone with reference to restorative proctocolectomy and the columnar cuff. Br J Surg. 1998; 85(11):1517-21. DOI: 10.1046/j.1365-2168.1998.00875.x. View

18.

Gionchetti P, Rizzello F, Venturi A, Brigidi P, Matteuzzi D, Bazzocchi G . Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial. Gastroenterology. 2000; 119(2):305-9. DOI: 10.1053/gast.2000.9370. View

19.

Phang P, Hain J, Madoff R, Gemlo B . Techniques and complications of ileostomy takedown. Am J Surg. 1999; 177(6):463-6. DOI: 10.1016/s0002-9610(99)00091-4. View

20.

Parks A . Transanal technique in low rectal anastomosis. Proc R Soc Med. 1972; 65(11):975-6. PMC: 1644685. View