Clin Colon Rectal Surg 2010; 23(4): 239-247
DOI: 10.1055/s-0030-1268250
© Thieme Medical Publishers

Technical Aspects of Ileoanal Pouch Surgery in Patients with Ulcerative Colitis

Hasan T. Kirat1 , Feza H. Remzi1
  • 1Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio
Further Information

Publication History

Publication Date:
07 December 2010 (online)


Restorative proctocolectomy with ileal pouch-anal anastomosis is the procedure of choice for patients with ulcerative colitis requiring surgery. A J-pouch with a stapled anastomosis has been the preferred technique because it is quicker, safer, and associated with good functional outcomes. A diverting loop ileostomy is usually created at the time of ileal pouch-anal anastomosis. In patients with severe fulminant colitis or toxic megacolon, restorative proctocolectomy with ileal pouch-anal anastomosis is performed in multistages. The technical aspects of ileal pouch-anal anastomosis in patients with ulcerative colitis are reviewed in this article.


  • 1 Fazio V W, Ziv Y, Church J M et al.. Ileal pouch-anal anastomoses complications and function in 1005 patients.  Ann Surg. 1995;  222(2) 120-127
  • 2 Meagher A P, Farouk R, Dozois R R, Kelly K A, Pemberton J H. J ileal pouch-anal anastomosis for chronic ulcerative colitis: complications and long-term outcome in 1310 patients.  Br J Surg. 1998;  85(6) 800-803
  • 3 Parks A G, Nicholls R J. Proctocolectomy without ileostomy for ulcerative colitis.  BMJ. 1978;  2(6130) 85-88
  • 4 Fazio V W, O'Riordain M G, Lavery I C et al.. Long-term functional outcome and quality of life after stapled restorative proctocolectomy.  Ann Surg. 1999;  230(4) 575-584 discussion 584-586
  • 5 Kirat H T, Remzi F H, Kiran R P, Fazio V W. Comparison of outcomes after hand-sewn versus stapled ileal pouch-anal anastomosis in 3,109 patients.  Surgery. 2009;  146(4) 723-729 discussion 729-730
  • 6 Remzi F H, Fazio V W, Delaney C P et al.. Dysplasia of the anal transitional zone after ileal pouch-anal anastomosis: results of prospective evaluation after a minimum of ten years.  Dis Colon Rectum. 2003;  46(1) 6-13
  • 7 Remzi F H, Fazio V W, Gorgun E et al.. The outcome after restorative proctocolectomy with or without defunctioning ileostomy.  Dis Colon Rectum. 2006;  49(4) 470-477
  • 8 El-Gazzaz G S, Kiran R P, Remzi F H, Hull T L, Geisler D P. Outcomes for case-matched laparoscopically assisted versus open restorative proctocolectomy.  Br J Surg. 2009;  96(5) 522-526
  • 9 McAllister I, Sagar P M, Brayshaw I, Gonsalves S, Williams G L. Laparoscopic restorative proctocolectomy with and without previous subtotal colectomy.  Colorectal Dis. 2009;  11(3) 296-301
  • 10 Fichera A, Silvestri M T, Hurst R D, Rubin M A, Michelassi F. Laparoscopic restorative proctocolectomy with ileal pouch anal anastomosis: a comparative observational study on long-term functional results.  J Gastrointest Surg. 2009;  13(3) 526-532
  • 11 Tilney H S, Lovegrove R E, Heriot A G et al.. Comparison of short-term outcomes of laparoscopic vs open approaches to ileal pouch surgery.  Int J Colorectal Dis. 2007;  22(5) 531-542
  • 12 Lovegrove R E, Heriot A G, Constantinides V et al.. Meta-analysis of short-term and long-term outcomes of J, W and S ileal reservoirs for restorative proctocolectomy.  Colorectal Dis. 2007;  9(4) 310-320
  • 13 Lovegrove R E, Constantinides V A, Heriot A G et al.. A comparison of hand-sewn versus stapled ileal pouch anal anastomosis (IPAA) following proctocolectomy: a meta-analysis of 4183 patients.  Ann Surg. 2006;  244(1) 18-26
  • 14 Weston-Petrides G K, Lovegrove R E, Tilney H S et al.. Comparison of outcomes after restorative proctocolectomy with or without defunctioning ileostomy.  Arch Surg. 2008;  143(4) 406-412
  • 15 Wong K S, Remzi F H, Gorgun E et al.. Loop ileostomy closure after restorative proctocolectomy: outcome in 1,504 patients.  Dis Colon Rectum. 2005;  48(2) 243-250
  • 16 Tekkis P P, Heriot A G, Smith J J, Das P, Canero A, Nicholls R J. Long-term results of abdominal salvage surgery following restorative proctocolectomy.  Br J Surg. 2006;  93(2) 231-237
  • 17 Mathis K L, Dozois E J, Larson D W, Cima R R, Wolff B G, Pemberton J H. Outcomes in patients with ulcerative colitis undergoing partial or complete reconstructive surgery for failing ileal pouch-anal anastomosis.  Ann Surg. 2009;  249(3) 409-413
  • 18 Remzi F H, Fazio V W, Kirat H T, Wu J S, Lavery I C, Kiran R P. Repeat pouch surgery by the abdominal approach safely salvages failed ileal pelvic pouch.  Dis Colon Rectum. 2009;  52(2) 198-204
  • 19 Garrett K A, Remzi F H, Kirat H T, Fazio V W, Shen B, Kiran R P. Outcome of salvage surgery for ileal pouches referred with a diagnosis of Crohn's disease.  Dis Colon Rectum. 2009;  52(12) 1967-1974

Feza H RemziM.D. 

Department of Colorectal Surgery, A30

Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195