Abstract
Restorative proctocolectomy with ileal pouch-anal anastomosis (RP/IPAA) is the procedure of choice for patients with ulcerative colitis and selected patients with familial adenomatous polyposis [1, 2] (Fig. 20.1). J-pouch is the most commonly used reservoir because it is easier to construct compared with S or W pouches [2] (Fig. 20.2). Stapled IPAA has become the preferred approach with good long-term functional outcomes and quality of life (QOL) over a hand-sewn anastomosis [3] (Fig. 20.3). In patients with toxic megacolon or severe fulminant colitis, RP/IPAA is performed in multistages including subtotal colectomy and end ileostomy and then in about 6 months completion proctectomy and IPAA with/without diverting ileostomy. Ileostomy is closed in 3 months following IPAA after checking integrity of pouch and IPAA using water-contrasted enema.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. Br Med J. 1978;2:85–8.
Fazio VW, O’Riordain MG, Lavery IC, et al. Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg. 1999;230:575–84; discussion 584–6.
Kirat HT, Remzi FH, Kiran RP, Fazio VW. Comparison of outcomes after hand-sewn versus stapled ileal pouch-anal anastomosis in 3,109 patients. Surgery. 2009;146:723–9.
Hueting WE, Buskens E, van der Tweel I, Gooszen HG, van Laarhoven CJ. Results and complications after ileal pouch anal anastomosis: a meta-analysis of 43 observational studies comprising 9,317 patients. Dig Surg. 2005;22:69–79.
Fazio VW, Tekkis PP, Remzi F, Lavery IC, Manilich E, Connor J, Preen M, Delaney CP. Quantification of risk for pouch failure after ileal pouch anal anastomosis surgery. Ann Surg. 2003;238:605–14; discussion 614–7.
Dehni N, Remacle G, Dozois RR, Banchini F, Tiret E, Parc R. Salvage reoperation for complications after ileal pouch-anal anastomosis. Br J Surg. 2005;92:748–53.
Shawki S, Belizon A, Person B, Weiss EG, Sands DR, Wexner SD. What are the outcomes of reoperative restorative proctocolectomy and ileal pouch-anal anastomosis surgery? Dis Colon Rectum. 2009;52:884–90.
Shah NS, Remzi FH, Massmann A, Baixauli J, Fazio VW. Management and treatment outcome of pouch-vaginal fistulas following restorative proctocolectomy. Dis Colon Rectum. 2003;46:911–7.
MacLean AR, O’Connor B, Parkes R, Cohen Z, McLeod RS. Reconstructive surgery for failed ileal pouch-anal anastomosis: a viable surgical option with acceptable results. Dis Colon Rectum. 2002;45:880–6.
Fonkalsrud EW, Bustorff-Silva J. Reconstruction for chronic dysfunction of ileoanal pouches. Ann Surg. 1999;229:197–204.
Fazio VW, Wu JS, Lavery IC. Repeat ileal pouch-anal anastomosis to salvage septic complications of pelvic pouches: clinical outcome and quality of life assessment. Ann Surg. 1998;228:588–97.
Baixauli J, Delaney CP, Wu JS, Remzi FH, Lavery IC, Fazio VW. Functional outcome and quality of life after repeat ileal pouch-anal anastomosis for complications of ileoanal surgery. Dis Colon Rectum. 2004;47:2–11.
Mathis KL, Dozois EJ, Larson DW, Cima RR, Wolff BG, Pemberton JH. Outcomes in patients with ulcerative colitis undergoing partial or complete reconstructive surgery for failing ileal pouch-anal anastomosis. Ann Surg. 2009;249:409–13.
Tekkis PP, Heriot AG, Smith JJ, Das P, Canero A, Nicholls RJ. Long-term results of abdominal salvage surgery following restorative proctocolectomy. Br J Surg. 2006;93:231–7.
Remzi FH, Fazio VW, Kirat HT, Wu JS, Lavery IC, Kiran RP. Repeat pouch surgery by the abdominal approach safely salvages failed ileal pelvic pouch. Dis Colon Rectum. 2009;52:198–204.
Garrett KA, Remzi FH, Kirat HT, Fazio VW, Shen B, Kiran RP. Outcome of salvage surgery for ileal pouches referred with a diagnosis of Crohn’s disease. Dis Colon Rectum. 2009;52:1967–74.
Kirat HT, Kiran RP, Oncel M, Shen B, Fazio VW, Remzi FH. Management of leak from the tip of the “j” in ileal pouch-anal anastomosis. Dis Colon Rectum. 2011;54:454–9.
Tan HT, Morton D, Connolly AB, Pringle W, White M, Keighley MR. Quality of life after pouch excision. Br J Surg. 1998;85:249–51.
Lepistö A, Luukkonen P, Järvinen HJ. Cumulative failure rate of ileal pouch-anal anastomosis and quality of life after failure. Dis Colon Rectum. 2002;45:1289–94.
Das P, Smith JJ, Tekkis PP, Heriot AG, Antropoli M, John Nicholls R. Quality of life after indefinite diversion/pouch excision in ileal pouch failure patients. Colorectal Dis. 2007;9:718–24.
Bengtsson J, Börjesson L, Willén R, Oresland T, Hultén L. Can a failed ileal pouch anal anastomosis be left in situ? Colorectal Dis. 2007;9:503–8.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer-Verlag London Limited
About this chapter
Cite this chapter
Kirat, H.T., Remzi, F.H. (2012). Failing Pouch. In: Brown, S., Hartley, J., Hill, J., Scott, N., Williams, J. (eds) Contemporary Coloproctology. Springer, London. https://doi.org/10.1007/978-0-85729-889-8_20
Download citation
DOI: https://doi.org/10.1007/978-0-85729-889-8_20
Published:
Publisher Name: Springer, London
Print ISBN: 978-0-85729-888-1
Online ISBN: 978-0-85729-889-8
eBook Packages: MedicineMedicine (R0)