Surgical interventions in inflammatory bowel disease: Indications, techniques, outcomes, and future directions

Table 3 Ileal pouch-anal anastomosis vs permanent end ileostomy in ulcerative colitis

Domain	IPAA (ileal pouch-anal anastomosis)	Permanent end ileostomy
Disease control	Removes colon/rectum; pouchitis common long-term	Removes colon/rectum; no pouchitis risk
Bowel function	5-8 BMs/day, some urgency/soilage; improves over time	4-6 stoma emptyings/day; predictable but appliance-dependent
Major complications	Pouchitis, pelvic sepsis, strictures, pouch failure	Parastomal hernia, skin problems, retraction/prolapse
Quality of life (global)	Generally “better or much better” than pre-op in > 80% of patients	Often improved vs pre-op; many report good HRQOL but with body-image issues
Sexual function	Small but real risk of pelvic nerve injury; most maintain function	Less pelvic dissection if rectum spared; function often preserved
Decisional aspects	More complex risk–benefit discussion; strong preference to avoid stoma	Some patients prefer predictable stoma to fear of pouch failure

IPAA: Ileal pouch-anal anastomosis; HRQOL: Health-related quality of life.