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Optimal Design for Ileal-Pouch Anal Anastomosis

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Mastery of IBD Surgery

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Abstract

Since its description in 1978, the ileal-pouch anal anastomosis (IPAA) has become the most commonly performed procedure for patients with ulcerative colitis requiring surgery. The earliest description of the IPAA included a three-limb “S” pouch with a hand-sewn pouch-anal anastomosis. Several years later, a two-limb “J” pouch was described, which, with the advent of the surgical stapler, became the procedure of choice due to its ease of construction. As practice patterns have changed over time, the optimal pouch configuration has been debated in the literature. Both the S-pouch and J-pouch configurations have well described functional and complication profiles. In this chapter, the literature comparing the complication rates and functional results of these pouches is reviewed. Specifically, we detail several studies examining complications such as pouch failure, pouchitis and mechanical obstruction, as well as functional outcomes such as stool frequency, incontinence, and the need for anti-diarrheal medications. Our analysis of the literature is followed by our recommendation on the optimal design for IPAA.

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Authors and Affiliations

  1. Division of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA, USA

    Paul M. Cavallaro & Richard A. Hodin

Authors
  1. Paul M. Cavallaro
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  2. Richard A. Hodin
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Correspondence to Paul M. Cavallaro .

Editor information

Editors and Affiliations

  1. Colon and Rectal Surgery, University of Chicago, Chicago, IL, USA

    Neil Hyman

  2. Section of Colon and Rectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Phillip Fleshner

  3. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Scott Strong

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Cavallaro, P.M., Hodin, R.A. (2019). Optimal Design for Ileal-Pouch Anal Anastomosis. In: Hyman, N., Fleshner, P., Strong, S. (eds) Mastery of IBD Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-16755-4_34

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  • DOI: https://doi.org/10.1007/978-3-030-16755-4_34

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-16754-7

  • Online ISBN: 978-3-030-16755-4

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