Clin Colon Rectal Surg 2004; 17(1): 35-41
DOI: 10.1055/s-2004-823069
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Technical Aspects of Ileoanal Pouch Surgery

Peter W. G. Carne1 , John H. Pemberton1
  • 1Division of Colon and Rectal Surgery, Mayo Clinic Foundation, Rochester, Minnesota
Further Information

Publication History

Publication Date:
13 April 2004 (online)

Ileal pouch-anal anastomosis has become the surgical procedure of choice for chronic ulcerative colitis. Since the initial description of the technique, various modifications have facilitated its evolution into a safe operation with excellent long-term outcomes. However, some aspects of the operation remain contentious. Our aim is to describe the technical aspects of ileal pouch-anal anastomosis and review the current literature in the areas of controversy.

REFERENCES

  • 1 Farouk R, Pemberton J H, Wolff B G, Dozois R R, Browning S, Larson D. Functional outcomes after ileal pouch-anal anastomosis for chronic ulcerative colitis.  Ann Surg. 2000;  231 919-926
  • 2 Pemberton J H, Phillips S F, Ready R R, Zinsmeister A R, Beahrs O H. Quality of life after Brooke ileostomy and ileal pouch-anal anastomosis. Comparison of performance status.  Ann Surg. 1989;  209 620-628
  • 3 Köhler L W, Pemberton J H, Zinsmeister A R, Kelly K A. Quality of life after proctocolectomy. A comparison of Brooke ileostomy, Koch pouch and ileal pouch- anal anastomosis.  Gastroenterology. 1991;  101 679-684
  • 4 Parks A G, Nicholls R J. Proctocolectomy without ileostomy for ulcerative colitis.  BMJ. 1978;  2 85-88
  • 5 Meagher A P, Farouk R, Dozois R R, Kelly K A, Pemberton J H. J ileal pouch-anal anastomosis for chronic ulcerative colitis: complication and long-term outcome in 1310 patients.  Br J Surg. 1998;  85 800-803
  • 6 Goudet P, Dozois R R, Kelly K A, Ilstrup D M, Phillips S F. Characteristics and evolution of extraintestinal manifestations associated with ulcerative colitis after proctocolectomy.  Dig Surg. 2001;  18 51-55
  • 7 Taylor B, Wolff B G, Dozois R R, Kelly K A, Pemberton J H, Beart Jr R W. Ileal pouch-anal anastomosis for chronic ulcerative colitis and familial polyposis coli complicated by adenocarcinoma.  Dis Colon Rectum. 1988;  31 358-362
  • 8 Delaney C P, Dadvand B, Remzi F H, Church J M, Fazio V W. Functional outcome, quality of life, and complications after ileal pouch-anal anastomosis in selected septuagenarians.  Dis Colon Rectum. 2002;  45 890-894
  • 9 Ambroze Jr W L, Wolff B G, Kelly K A, Beart Jr R W, Dozois R R, Ilstrup D M. Let sleeping dogs lie: the role of the omentum in the ileal pouch-anal anastomosis operation.  Dis Colon Rectum. 1991;  34 563-565
  • 10 Ballantyne G H, Pemberton J H, Beart Jr R W, Wolff B G, Dozois R R. Ileal J pouch-anal anastomosis. Current technique.  Dis Colon Rectum. 1985;  28 197-202
  • 11 Nicholls R J, Lubowski D Z. Restorative proctocolectomy: the four loop (W) reservoir.  Br J Surg. 1987;  74 564-566
  • 12 Lindsey I, George B D, Kettlewell G W, Mortensen N JM. Impotence after mesorectal and close dissection for inflammatory bowel disease.  Dis Colon Rectum. 2001;  44 831-835
  • 13 Ambroze Jr W L, Pemberton J H, Dozois R R, Carpenter H A, O'Rourke J S, Ilstrup D M. The histological pattern and pathological involvement of the anal transition zone in patients with ulcerative colitis.  Gastroenterology. 1993;  104 514-518
  • 14 Deen K I, Williams J G, Billingham G C, Keighley M RB. Randomized trial to determine the optimum level of pouch-anal anastomosis in stapled restorative proctocolectomy.  Dis Colon Rectum. 1995;  38 133-138
  • 15 O'Connell P R, Pemberton J H, Weiland L H et al.. Does rectal mucosa regenerate after ileoanal anastomosis?.  Dis Colon Rectum. 1987;  30 1-5
  • 16 Remzi F H, Fazio V W, Delaney C P et al.. Dysplasia of the anal transition zone after ileal pouch-anal anastomosis. Results of prospective evaluation after a minimum of ten years.  Dis Colon Rectum. 2003;  46 6-13
  • 17 Stern H, Walfisch S, Mullen B, McLeod R, Cohen Z. Cancer in an ileoanal reservoir: a new late complication?.  Gut. 1990;  31 473-475
  • 18 Rodriguez-Sanjuan J C, Polavieja M G, Naranjo A, Castillo J. Adenocarcinoma in an ileal pouch for ulcerative colitis.  Dis Colon Rectum. 1995;  38 779-780
  • 19 Laureti S, Ugolini F, D'Errico A et al.. Adenocarcinoma below ileoanal anastomosis for ulcerative colitis: report of a case and review of the literature.  Dis Colon Rectum. 2002;  45 418-421
  • 20 Sequens R. Cancer in the anal canal (transition zone) after restorative proctocolectomy with stapled ileal pouch anastomosis.  Int J Colorectal Dis. 1997;  12 254-257
  • 21 Baratsis S, Hadjidimitriou F, Christodoulou M, Lariou K. Adenocarcinoma in the anal canal after ileal pouch-anal anastomosis for ulcerative colitis using a double stapling technique: report of a case.  Dis Colon Rectum. 2002;  45 687-692
  • 22 Fazio V W, Tjandra J J. Transanal mucosectomy: ileal pouch advancement for anorectal dysplasia or inflammation after restorative proctocolectomy.  Dis Colon Rectum. 1994;  37 1008-1011
  • 23 Reilly W T, Pemberton J H, Wolff B G et al.. Randomized prospective trial comparing ileal pouch-anal anastomosis by excising the anal mucosa to ileal pouch-anal anastomosis performed by preserving the anal mucosa.  Ann Surg. 1997;  225 666-677
  • 24 Hallgren T A, Fasth S B, Öresland T O, Hultén L A. Ileal pouch anal function after endoanal mucosectomy and handsewn anastomosis compared with stapled anastomosis without mucosectomy.  Eur J Surg. 1995;  161 915-921
  • 25 Choen S, Tsunoda A, Nicholls R J. Prospective randomized trial comparing anal function after hand-sewn ileoanal anastomosis with mucosectomy versus stapled ileoanal anastomosis without mucosectomy in restorative proctocolectomy.  Br J Surg. 1991;  78 430-434
  • 26 Luukkeon O, Järvinen H. Stapled vs hand-sutured ileoanal anastomosis in restorative proctocolectomy.  Arch Surg. 1993;  128 437-440
  • 27 Ziv Y, Fazio V W, Church J M, Lavery I C, Ming King T, Ambrosetti P. Stapled ileal pouch-anal anastomoses are safer than handsewn anastomoses in patients with ulcerative colitis.  Am J Surg. 1996;  171 320-323
  • 28 Senagore A J, Billingham R P, Luchtefeld M A, Isler J T, Adkins T A. The single-stapled ileo pouch-anal anastomosis: a reasonable compromise.  Am Surg. 1996;  62 535-539
  • 29 Utsunomiya J, Iwama T, Imajo M et al.. Total colectomy, mucosal proctectomy and ileoanal anastomosis.  Dis Colon Rectum. 1980;  23 459-466
  • 30 Nicholls R J, Pezim M E. Restorative proctocolectomy with ileal reservoir for ulcerative colitis and familial adenomatous polyposis: a comparison of three reservoir designs.  Br J Surg. 1985;  72 470-474
  • 31 Hallgren T, Fasth S, Nordgren S, Öresland T, Hallsberg L, Hultén L. Manovolumetric characteristics and functional results in three different pelvic pouch designs.  Int J Colorectal Dis. 1989;  4 156-160
  • 32 Fonkalsrud E W. Update on clinical experiences with different surgical techniques of the endorectal pull-through operation for colitis and polyps.  Surg Gynecol Obstet. 1987;  165 309-316
  • 33 Slors J FM, Taat C W, Brummelkamp W H. Ileal pouch-anal anastomosis without rectal muscular cuff.  Int J Colorectal Dis. 1989;  4 178-181
  • 34 Nelson R L, Leela Prasad M, Pearl R K, Abcarian H. Inverted U-pouch construction for restoration of function in patients with failed straight ileoanal pull-throughs.  Dis Colon Rectum. 1991;  34 1040-1042
  • 35 Pescatori M, Manhire A, Bartram C I. Evacuation proctography in the evaluation of ileoanal reservoir function.  Dis Colon Rectum. 1983;  26 365-368
  • 36 Smith L, Friend W G, Medwell S J. The superior mesenteric artery. The critical factor in the pouch pull-through procedure.  Dis Colon Rectum. 1984;  27 741-744
  • 37 Sager P M, Holdsworth P J, Godwin P GR, Quirke P, Smith A N, Johnston D. Comparison of triplicated (S) and quadruplicated (W) pelvic ileal reservoirs. Studies on manuvolumetry, fecal bacteriology, fecal volatile fatty acids, mucosal morphology and functional results.  Gastoenterology. 1992;  102 520-528
  • 38 Johnston D, Williamson M ER, Lewis W G, Miller A S, Sagar P M, Holdsworth P J. Prospective controlled trial of duplicated (J) versus quadruplicated (W) pelvic ileal reservoirs in restorative proctocolectomy for ulcerative colitis.  Gut. 1996;  39 242-247
  • 39 Keighley M RB, Yoshioka K, Kmiot W. Prospective randomized trial to compare the stapled double lumen and the sutured quadruple pouch for restorative proctocolectomy.  Br J Surg. 1988;  75 1008-1011
  • 40 Selvaggi S F, Giuliani A, Gallo C, Signoriello G, Riegler G, Canonico S. Randomized, controlled trial to compare the J-pouch and W-pouch configurations for ulcerative colitis in the maturation period.  Dis Colon Rectum. 2000;  43 615-620
  • 41 Lumley J, Stevenson A, Stitz R. Prospective randomized study of J vs. W pouches in ulcerative colitis.  Dis Colon Rectum. 2002;  45 A5
  • 42 Martel P H, Majery N, Savigny B, Sezeur A, Gallot D, Malafosse M. Mesenteric lengthening in ileoanal pouch anastomosis for ulcerative colitis: is high ligation of the superior mesenteric pedicle a safe procedure?.  Dis Colon Rectum. 1998;  41 862-866
  • 43 Goes R N, Nguyen P, Huang D, Beart Jr R W. Lengthening of the mesentery using the marginal vascular arcade of the right colon as the blood supply to the ileal pouch.  Dis Colon Rectum. 1995;  38 893-895
  • 44 Browning S M, Nivatvongs S. Intraoperative abandonment of ileal pouch to anal anastomosis-the Mayo Clinic experience.  J Am Coll Surg. 1998;  186 441-446
  • 45 Farouk R, Dozois R R, Pemberton J H, Larson D. Incidence and subsequent impact of pelvic abscess after ileal pouch-anal anastomosis for chronic ulcerative colitis.  Dis Colon Rectum. 1998;  41 1239-1243
  • 46 Williamson M, Lewis W, Sagar P M, Holdsworth P J, Johnston D. One-stage restorative proctocolectomy without temporary ileostomy for ulcerative colitis: a note of caution.  Dis Colon Rectum. 1997;  40 1019-1022
  • 47 Metcalf A M, Dozois R R, Beart Jr R W, Kelly K A, Wolff B G. Temporary ileostomy for ileal pouch-anal anastomosis. Function and complications.  Dis Colon Rectum. 1986;  29 300-303
  • 48 Galandiuk S, Wolff B G, Dozois R R, Beart Jr R W. Ileal pouch-anal anastomosis without ileostomy.  Dis Colon Rectum. 1991;  34 870-873
  • 49 Sagar P M, Lewis W, Holdsworth P J, Johnston D. One-stage restorative proctocolectomy without temporary defunctioning ileostomy.  Dis Colon Rectum. 1992;  35 582-588
  • 50 Sugarman H J, Newsome H H. Stapled ileoanal anastomosis without a temporary ileostomy.  Am J Surg. 1994;  167 58-66
  • 51 Sugerman H J, Sugerman E L, Meador J G, Newsome H H, Kellum J M, DeMaria E J. Ileal pouch anal anastomosis without ileal diversion.  Ann Surg. 2000;  232 530-541
  • 52 Grobler S P, Hosie K B, Keighley M RB. Randomized trial of loop ileostomy in restorative proctocolectomy.  Br J Surg. 1992;  79 903-906
  • 53 Young-Fadok T M, Dozois E J, Sandborn W J, Tremaine W J. A case matched study of laparoscopic proctocolectomy and ileal pouch-anal anastomosis(PC-IPAA) versus open PC-IPAA for ulcerative colitis.  Gastroenterology. 2001;  A-452 2302
  • 54 Marcello P W, Milsom J W, Wong S K et al.. Laparoscopic restorative proctocolectomy: case-matched comparative study with open restorative proctocolectomy.  Dis Colon Rectum. 2000;  43 604-608
  • 55 Dunker M S, Bemelman W A, Slors J FM, van Duijvendijk P, Gouma D J. Functional outcome, quality of life, body image and cosmesis in patients after laparoscopic-assisted and conventional restorative proctocolectomy: a comparative study.  Dis Colon Rectum. 2001;  44 1800-1807
  • 56 Schmitt S L, Cohen S M, Wexner S D, Nogueras J J, Jagelman D G. Does laparoscopic-assisted ileal pouch-anal anastomosis reduce the length of hospitalization?.  Int J Colorectal Dis. 1994;  9 134-137
  • 57 Stevenson A, Lumley J, Stitz R. Decreased adhesions after laparoscopic-assisted colorectal resections.  Dis Colon Rectum. 2002;  45 -A25
  • 58 Marcello P, Mutch M, Herline A, Schoetz D. Laparoscopic colectomy prevents small bowel adhesions: an evaluation at reoperation.  Dis Colon Rectum. 2002;  45 -A25
  • 59 Francois Y, Dozois R R, Kelly  et al.. Small intestinal obstruction complicating ileal pouch-anal anastomosis.  Ann Surg. 1989;  209 46-50
  • 60 MacLean A R, Cohen Z, MacRae H M et al.. Risk of small bowel obstruction after the ileal pouch-anal anastomosis.  Ann Surg. 2002;  235 200-206
  • 61 Olsen K O, Joelsson M, Laurberg S, Oresland T. Fertility after ileal pouch-anal anastomosis in women with ulcerative colitis.  Br J Surg. 1999;  86 493-495

John H PembertonM.D. 

Division of Colon and Rectal Surgery

Mayo Clinic Foundation, 200 First Street SW

Rochester, MN 55905

Email: pemberton.john@mayo.edu