Seminars in Colon & Rectal Surgery
Volume 20, Issue 2 , Pages 93-102 , June 2009

Ileal Pouch Rectal Anastomosis: Technique, Indications, and Outcomes

  • Felix Averboukh, MD
  • ,
  • Yehuda Kariv, MD

      Affiliations

    • Corresponding Author InformationAddress reprint requests to: Yehuda Kariv, MD, Colorectal Surgery Unit, Division of Surgery B, Tel Aviv Sourasky Medical Center, 6 Weizman St, Tel-Aviv, Israel 64239

References 

  1. Nicholls RJ. Restorative proctocolectomy with various types of reservoir. World J Surg. 1987;11:751–762
  2. Fazio VW, Ziv Y, Church J, et al. Ileal pouch-anal anastomoses: Complications and function in 1,005 patients. Ann Surg. 1995;222:120–127
  3. Meagher AP, Farouk R, Dozois RR, et al. Ileal pouch-anal anastomosis for chronic ulcerative colitis. Br J Surg. 1998;85:800–803
  4. Onaitis MW, Mantyh C. Ileal pouch-anal anastomosis for ulcerative colitis and familial adenomatous polyposis: Historical development and current status. Ann Surg. 2003;238(suppl):S42–S48
  5. Fazio VW, O'Riordain MG, Lavery IC, et al. Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg. 1999;230:575–584
  6. Delaney CP, Fazio VW, Remzi FH, et al. Prospective, age-related analysis of surgical results, functional outcome, and quality of life after ileal pouch-anal anastomosis. Ann Surg. 2003;238:221–228
  7. McMurrick PJ, Dozois PR. Chronic ulcerative colitis: Surgical options. In:  Fazio VW,  Church JM,  Delaney CP editor. Current Therapy in Colon and Rectal Surgery. Philadelphia, PA: Elsevier Mosby; 2005;p. 211–217
  8. Farouk R, Pemberton JH, Wolff BG, et al. Functional outcomes after ileal pouch anal anastomosis for chronic ulcerative colitis. Ann Surg. 2000;231:919–926
  9. Kariv Y, Remzi FH, Strong SA, et al. Ileal pouch rectal anastomosis: A viable alternative to permanent ileostomy in Crohn's proctocolitis patients. J Am Coll Surg. 2009;208:390–399
  10. Chrysos E, Athanasakis E, Vassilakis JS, et al. Total colectomy and J-pouch ileorectal anastomosis for obstructed tumours of the rectosigmoid junction. ANZ J Surg. 2002;72:92–94
  11. Pastore RL, Wolff BG, Hodge D. Total abdominal colectomy and ileorectal anastomosis for inflammatory bowel disease. Dis Colon Rectum. 1997;40:1455–1464
  12. Elton C, Makin G, Hitos K, et al. Mortality, morbidity and functional outcome after ileorectal anastomosis. Br J Surg. 2003;90:59–65
  13. Khubchandani IT, Kontostolis SB. Outcome of ileorectal anastomosis in an inflammatory bowel disease surgery experience of three decades. Arch Surg. 1994;129:866–869
  14. Chevalier JM, Jones DJ, Ratelle R, et al. Colectomy and ileorectal anastomosis in patients with Crohn's disease. Br J Surg. 1994;81:1379–1381
  15. Bülow C, Vasen H, Järvinen H, et al. Ileorectal anastomosis is appropriate for a subset of patients with familial adenomatous polyposis. Gastroenterology. 2000;119:1454–1460
  16. Fajobi O, Yiu CY, Sen Gupta SB, et al. Metachronous colorectal cancers. Br J Surg. 1998;85:897–901
  17. Piccirillo MF, Reissman P, Wexner SD. Colectomy as treatment for constipation in selected patients. Br J Surg. 1995;82:898–901
  18. Wexner SD, Alabaz O. Anastomotic integrity and function: Role of the colonic J-pouch. Semin Surg Oncol. 1998;15:91–100
  19. Hueting WE, Buskens E, van der Tweel I, et al. Results and complications after ileal pouch anal anastomosis: A meta-analysis of 43 observational studies comprising 9317 patients. Digest Surg. 2005;22:69–79
  20. Fazio VW, Tekkis PP, Remzi F, et al. Quantification of risk for pouch failure after ileal pouch anal anastomosis surgery. Ann Surg. 2003;238:605–617
  21. Johansen C, Bitsch M, Bulow S. Fertility and pregnancy in women with familial adenomatous polyposis. Int J Colorect. 1990;5:203–206
  22. Olsen KO, Juul S, Berndtsson I, et al. Ulcerative colitis: Female fecundity before diagnosis, during disease, and after surgery compared with a population sample. Gastroenterology. 2002;122:15–19
  23. Olsen KO, Juul S, Bulow S, et al. Female fecundity before and after operation for familial adenomatous polyposis. Br J Surg. 2003;90:227–231
  24. Fazio VW, Wu JS. Surgical therapy for Crohn's disease of the colon and rectum. Surg Clin North Am. 1997;77:197–210
  25. Guy TS, Williams NN, Rosato EF. Crohn's disease of the colon. Surg Clin North Am. 2001;81:159–168
  26. Panis Y, Poupard B, Nemeth J, et al. Ileal pouch/anal anastomosis for Crohn's disease. Lancet. 1996;347:854–857
  27. Phillips RK. Ileal pouch-anal anastomosis for Crohn's disease. Gut. 1998;43:303–304
  28. Regimbeau JM, Panis Y, Pocard M, et al. Long term results of ileal pouch-anal anastomosis for colorectal Crohn's disease. Dis Colon Rectum. 2001;44:769–778
  29. de Oca J, Sanchez-Santos R, Rague JM, et al. Long-term results of ileal pouch-anal anastomosis in Crohn's disease. Inflamm Bowel Dis. 2003;9:171–175
  30. Hartley JE, Fazio VW, Remzi FH, et al. Analysis of the outcome of ileal pouch-anal anastomosis in patients with Crohn's disease. Dis Colon Rectum. 2004;47:1808–1815
  31. Brown CJ, Maclean AR, Cohen Z, et al. Crohn's disease and indeterminate colitis and the ileal pouch-anal anastomosis: Outcomes and patterns of failure. Dis Colon Rectum. 2005;48:1542–1549
  32. Braveman JM, Schoetz DJ, Marcello PW, et al. The fate of the ileal pouch in patients developing Crohn's disease. Dis Colon Rectum. 2004;47:1613–1619
  33. Tekkis PP, Heriot AG, Smith O, et al. Long-term outcomes of restorative proctocolectomy for Crohn's disease and indeterminate colitis. Colorectal Dis. 2005;7:218–223
  34. Melton GB, Fazio VW, Kiran RP, et al. Long-term outcomes with ileal pouch-anal anastomosis and Crohn's disease: Pouch retention and implications of delayed diagnosis. Ann Surg. 2008;248:608–616
  35. Bernell O, Lapidus A, Hellers G. Recurrence after colectomy in Crohn's colitis. Dis Colon Rectum. 2001;44:647–654
  36. Yamamoto T, Keighley MR. Fate of the rectum and ileal recurrence rates after total colectomy for Crohn's disease. World J Surg. 2000;24:125–129
  37. Yamamoto T. Factors affecting recurrence after surgery for Crohn's disease. World J Gastroenterol. 2005;11:3971–3979
  38. Buchmann P, Weterman IT, Keighley MR, et al. The prognosis of ileorectal anastomosis in Crohn's disease. Br J Surg. 1981;68:7–10
  39. Cattan P, Bonhomme N, Panis Y, et al. Fate of the rectum in patients undergoing total colectomy for Crohn's disease. Br J Surg. 2002;89:454–459
  40. Longo WE, Oakley JR, Lavery IC, et al. Outcome of ileorectal anastomosis for Crohn's colitis. Dis Colon Rectum. 1992;35:1066–1071
  41. Harling H, Hegnhoj J, Rasmussen TN, et al. Fate of the rectum after colectomy and ileostomy for Crohn's colitis. Dis Colon Rectum. 1991;34:931–935
  42. Sands BE, Anderson FH, Bernstein CN, et al. Infliximab maintenance therapy for fistulizing Crohn's disease. N Engl J Med. 2004;350:876–885
  43. Colombel JF, Ricart E, Loftus EV, et al. Management of Crohn's disease of the ileoanal pouch with infliximab. Am J Gastroenterol. 2003;98:2239–2244
  44. Maclean AR, Cohen Z, MacRae HM, et al. Risk of small bowel obstruction after the ileal pouch-anal anastomosis. Ann Surg. 2002;235:200–206
  45. Bernell O, Lapidus A, Hellers G. Risk factors for surgery and postoperative recurrence in Crohn's disease. Ann Surg. 2000;231:38–45
  46. Oakley JR, Lavery IC, Fazio VW, et al. The fate of the rectal stump after subtotal colectomy for ulcerative colitis. Dis Colon Rectum. 1985;28:394–396
  47. Börjesson L, Lundstam U, Oresland T, et al. The place for colectomy and ileorectal anastomosis: A valid surgical option for ulcerative colitis?. Tech Coloproctol. 2006;10:237–241
  48. Parc R, Legrand M, Frileux P, et al. Comparative clinical results of ileal-pouch anal anastomosis and ileorectal anastomosis in ulcerative colitis. Hepatogastroenterology. 1989;36:235–239
  49. Tulchinsky H, McCourtney JS, Rao KV, et al. Salvage abdominal surgery in patients with a retained rectal stump after restorative proctocolectomy and stapled anastomosis. Br J Surg. 2001;88:1602–1606
  50. Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. BMJ. 1978;2:85–88
  51. Lavery IC, Sirimarco MT, Ziv Y, et al. Anal canal inflammation after ileal pouch-anal anastomosis (The need for treatment). Dis Colon Rectum. 1995;38:803–806
  52. Shen B, Lashner BA, Bennett AE, et al. Treatment of rectal cuff inflammation (cuffitis) in patients with ulcerative colitis following restorative proctocolectomy and ileal pouch-anal anastomosis. Am J Gastroenterol. 2004;99:1527–1531
  53. Fazio VW, Tjandra JJ. Transanal mucosectomy (Ileal pouch advancement for anorectal dysplasia or inflammation after restorative proctocolectomy). Dis Colon Rectum. 1994;37:1008–1011
  54. Ooi BS, Remzi FH, Gramlich T, et al. Anal transitional zone cancer after restorative proctocolectomy and ileoanal anastomosis in familial adenomatous polyposis: Report of two cases. Dis Colon Rectum. 2003;46:1418–1423
  55. Remzi FH, Fazio VW, Delaney CP, 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;46:6–13
  56. Branco BC, Sachar DB, Heimann TM, et al. Adenocarcinoma following ileal pouch-anal anastomosis for ulcerative colitis: Review of 26 cases. Inflamm Bowel Dis. 2009;15:295–299
  57. Tekkis PP, Heriot AG, Smith JJ, et al. Long-term results of abdominal salvage surgery following restorative proctocolectomy. Br J Surg. 2006;93:231–237
  58. Rotholtz NA, Pikarsky AJ, Singh JJ, et al. Adenocarcinoma arising from along the rectal stump after double-stapled ileorectal J-pouch in a patient with ulcerative colitis: The need to perform a distal anastomosis (Report of a case). Dis Colon Rectum. 2001;44:1214–1217
  59. Lepistö A, Sarna S, Tiitinen A, et al. Female fertility and childbirth after ileal pouch-anal anastomosis for ulcerative colitis. Br J Surg. 2007;94:478–482
  60. Waljee A, Waljee J, Morris AM, et al. 3-Fold increased risk of infertility: A meta-analysis of infertility after ileal pouch anal anastomosis in ulcerative colitis. Gut. 2006;55:1575–1580
  61. Ørding Olsen K, Juul S, Berndtsson I, et al. Ulcerative colitis: Female fecundity before diagnosis, during disease, and after surgery compared with a population sample. Gastroenterology. 2002;122:15–19
  62. Mortier PE, Gambiez L, Karoui M, et al. Colectomy with ileorectal anastomosis preserves female fertility in ulcerative colitis. Gastroenterologie Clin Biol. 2006;30:594–597
  63. Arenas RB, Fichera A, Mhoon D, et al. Incidence and therapeutic implications of synchronous colonic pathology in colorectal adenocarcinoma. Surgery. 1997;122:706–710
  64. Fante R, Roncucci L, Di G, et al. Frequency and clinical features of multiple tumors of the large bowel in the general population and in patients with hereditary colorectal carcinoma. Cancer. 1996;77:2013–2021
  65. Möslein G, Pistorius S, Saeger HD, et al. Preventive surgery for colon cancer in familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer syndrome. Langenbecks Arch Surg. 2003;388:9–16
  66. Vasen HF, Möslein G, Alonso A, et al. Guidelines for the clinical management of Lynch's syndrome (hereditary non-polyposis cancer). J Med Genet. 2007;44:353–362
  67. Syngal S, Weeks JC, Schrag D, et al. Benefits of colonoscopic surveillance and prophylactic colectomy in patients with hereditary nonpolyposis colorectal cancer mutations. Ann Intern Med. 1998;129:787–796
  68. Aarnio M, Mecklin JP, Aaltonen LA, et al. Life-time risk of different cancers in hereditary non-polyposis colorectal cancer (HNPCC) syndrome. Int J Cancer. 1995;64:430–433
  69. Rodriguez-Bigas MA, Vasen HF, Pekka-Mecklin J, et al. Rectal cancer risk in hereditary nonpolyposis colorectal cancer after abdominal colectomy (International Collaborative Group on HNPCC). Ann Surg. 1997;225:202–207
  70. Lynch HT. Is there a role for prophylactic subtotal colectomy among hereditary nonpolyposis colorectal cancer germline mutation carriers?. Dis Colon Rectum. 1996;39:109–110
  71. de Vos Tot Nederveen Cappel WH, Buskens E, van Duijvendijk P, et al. Decision analysis in the surgical treatment of colorectal cancer due to a mismatch repair gene defect. Gut. 2003;52:1752–1755
  72. Stewart J, Diament RH, Brennan TG. Management of obstructing lesions of the left colon by resection, on-table lavage, and primary anastomosis. Surgery. 1993;114:502–505
  73. The SCOTIA Study Group. Subtotal colectomy versus on-table irrigation and anastomosis (Single-stage treatment for malignant left-sided colonic obstruction: A prospective randomized clinical trial comparing subtotal colectomy with segmental resection following intraoperative irrigation). Br J Surg. 1995;82:1622–1627
  74. Torralba JA, Robles R, Parrilla P, et al. Subtotal colectomy versus intraoperative colonic irrigation in the management of obstructed left colon carcinoma. Dis Colon Rectum. 1998;41:18–22
  75. Reemst PH, Kuijpers HC, Wobbes T. Management of left-sided colonic obstruction by subtotal colectomy and ileocolic anastomosis. Eur J Surg. 1998;164:537–540
  76. Joo JS, Latulippe JF, Alabaz O, et al. Long-term functional evaluation of straight coloanal anastomosis and colonic J-pouch. Dis Colon Rectum. 1998;41:740–746
  77. Mortensen NJ, Ramirez JM, Takeuchi N, et al. Colonic J pouch anal anastomosis after rectal excision for carcinoma: Functional outcome. Br J Surg. 1995;82:611–613
  78. Vasen HF, Möslein G, Alonso A, et al. Guidelines for the clinical management of familial adenomatous polyposis (FAP). Gut. 2008;57:704–713
  79. Bülow S, Bülow C, Vasen H, et al. Colectomy and ileorectal anastomosis is still an option for selected patients with familial adenomatous polyposis. Dis Colon Rectum. 2008;51:1318–1323
  80. Soravia C, Klein L, Berk T, et al. Comparison of ileal pouch-anal anastomosis and ileorectal anastomosis in patients with familial adenomatous polyposis. Dis Colon Rectum. 1999;42:1028–1034
  81. Aziz O, Athanasiou T, Fazio VW, et al. Meta-analysis of observational studies of ileorectal versus ileal pouch-anal anastomosis for familial adenomatous polyposis. Br J Surg. 2006;93:407–417
  82. Nyam DC, Brillant PT, Dozois RR, et al. Ileal pouch-anal canal anastomosis for familial adenomatous polyposis: Early and late results. Ann Surg. 1997;226:514–519
  83. Parc YR, Olschwang S, Desaint B, et al. Familial adenomatous polyposis: Prevalence of adenomas in the ileal pouch after restorative proctocolectomy. Ann Surg. 2001;233:360–364
  84. Vasen HF, van der Luijt RB, Slors JF, et al. Molecular genetic tests as a guide to surgical management of familial adenomatous polyposis. Lancet. 1996;348:433–435
  85. Church J. In which patients do I perform IRA, and why?. Familial Cancer. 2006;5:237–240
  86. Church J, Burke C, McGannon E, et al. Predicting polyposis severity proctoscopy: How reliable is it?. Dis Colon Rectum. 2001;44:1249–1254
  87. Soravia C, O'Connor BI, Berk T, et al. Functional outcome of conversion of ileorectal anastomosis to ileal pouch-anal anastomosis in patients with familial adenomatous polyposis and ulcerative colitis. Dis Colon Rectum. 1999;42:903–908
  88. Sampson JR, Dolwani S, Jones S, et al. Autosomal recessive colorectal adenomatous polyposis due to inherited mutations of MYH. Lancet. 2003;362:39–41
  89. Oncel M, Church JM, Remzi FH, et al. Colonic surgery in patients with juvenile polyposis syndrome: A case series. Dis Colon Rectum. 2005;48:49–55
  90. Pemberton JH, Rath DM, Ilstrup DM. Evaluation and surgical treatment of severe chronic constipation. Ann Surg. 1991;214:403–411
  91. Hosie KB, Kmiot WA, Keighley MR. Constipation: Another indication for restorative proctocolectomy. Br J Surg. 1990;77:801–802
  92. Gladman MA, Scott SM, Lunniss PJ, et al. Systematic review of surgical options for idiopathic megarectum and megacolon. Ann Surg. 2005;241:562–574
  93. Stewart J, Kumar D, Keighley MR. Results of anal or low rectal anastomosis and pouch construction for megarectum and megacolon. Br J Surg. 1994;81:1051–1053

PII: S1043-1489(09)00011-6

doi: 10.1053/j.scrs.2009.05.007

Seminars in Colon & Rectal Surgery
Volume 20, Issue 2 , Pages 93-102 , June 2009