Ileal Pouch-Anal Anastomosis: Indications and Technique

Restorative proctocolectomy and ileal pouch anal anastomosis (RP/IPAA) have been the procedures of choice for patients with ulcerative colitis, or familial adenomatous polyposis, and those with other diagnoses who require surgery. The options for this procedure are J, S, or W ileal pelvic pouch anastomosed by either stapled or hand-sewn technique. J-pouch is the preferred technique of most surgeons. The stapled IPAA is quicker, more secure, and safer, with better function, while the hand-sewn IPAA allows removal of the diseased anal transitional zone. Recently, in most of the centers, the use of a hand-sewn IPAA has been limited to those with dysplasia or lower rectum cancer and to when a stapled IPAA has failed. Although leaving intact rectal mucosa after stapled IPAA could be a potential concern in the development of dysplasia or cancer, it has been shown that anal transitional zone preservation rarely leads to the development of cancer. This review describes indications and techniques of RP/IPAA.