Abstract
Restorative proctocolectomy, or ileal pouch anal anastomosis, is considered the standard
treatment for intractable ulcerative colitis. When the pelvic pouch was first introduced
in 1978, a two-stage procedure with proctocolectomy, construction of the pelvic pouch,
and a diverting loop with subsequent closure were suggested. Over the decades that
the pelvic pouch has been around, some principal technical issues have been addressed
to improve the method. In more recent days the laparoscopic approach has been additionally
introduced. During the same time-period the medical arsenal has developed far more
with the increasing use of immune modulators and the introduction of biologicals.
Staging of restorative proctocolectomy with a pelvic pouch refers to how many sessions,
or stages, the procedure should be divided into. The main goal with restorative proctocolectomy
is a safe operation with optimal short- and long-term function. In this paper we aim
to review the present knowledge and views on staging of the pouch procedure in ulcerative
colitis, especially with consideration to the treatment with biologicals.
Keywords
ulcerative colitis - biological therapy - immunomodulators - surgery
