Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2019; 25(31): 4320-4342
Published online Aug 21, 2019. doi: 10.3748/wjg.v25.i31.4320
Ileal-anal pouches: A review of its history, indications, and complications
Kheng-Seong Ng, Simon Joseph Gonsalves, Peter Michael Sagar
Kheng-Seong Ng, Peter Michael Sagar, John Goligher Colorectal Unit, St. James’s University Hospital, Leeds LS9 7TF, United Kingdom
Kheng-Seong Ng, Institute of Academic Surgery, University of Sydney, Camperdown, New South Wales 2050, Australia
Simon Joseph Gonsalves, Department of Colorectal Surgery, Huddersfield Royal Infirmary, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield HD3 3EA, United Kingdom
Author contributions: All authors contributed to this article.
Supported by the Mitchell J. Notaras Fellowship in Colorectal Surgery.
Conflict-of-interest statement: No conflicts of interest exist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Peter Michael Sagar, BSc, FRCS, MD, Full Professor, Professor of Colorectal Surgery, John Goligher Colorectal Unit, St. James’s University Hospital, Beckett Street, Leeds LS9 7TF, United Kingdom.
Telephone: +44-113-2064498 Fax: +44-113-2067355
Received: February 13, 2019
Peer-review started: February 15, 2019
First decision: February 26, 2019
Revised: March 12, 2019
Accepted: March 24, 2019
Article in press: March 25, 2019
Published online: August 21, 2019

The ileal pouch anal anastomosis (IPAA) has revolutionised the surgical management of ulcerative colitis (UC) and familial adenomatous polyposis (FAP). Despite refinement in surgical technique(s) and patient selection, IPAA can be associated with significant morbidity. As the IPAA celebrated its 40th anniversary in 2018, this review provides a timely outline of its history, indications, and complications. IPAA has undergone significant modification since 1978. For both UC and FAP, IPAA surgery aims to definitively cure disease and prevent malignant degeneration, while providing adequate continence and avoiding a permanent stoma. The majority of patients experience long-term success, but “early” and “late” complications are recognised. Pelvic sepsis is a common early complication with far-reaching consequences of long-term pouch dysfunction, but prompt intervention (either radiological or surgical) reduces the risk of pouch failure. Even in the absence of sepsis, pouch dysfunction is a long-term complication that may have a myriad of causes. Pouchitis is a common cause that remains incompletely understood and difficult to manage at times. 10% of patients succumb to the diagnosis of pouch failure, which is traditionally associated with the need for pouch excision. This review provides a timely outline of the history, indications, and complications associated with IPAA. Patient selection remains key, and contraindications exist for this surgery. A structured management plan is vital to the successful management of complications following pouch surgery.

Keywords: Ileal pouch, Restorative proctocolectomy, Ulcerative colitis, Crohn’s disease, Familial adenomatous polyposis

Core tip: The ileal pouch remains a mainstay for the surgical management of ulcerative colitis and familial adenomatous polyposis. From its inception in 1978, there have been developments in the technical approaches to this surgery, with recent advancements including robotic surgery, transanal proctectomy, and single incision laparoscopic surgery. Despite these advancements, pouch surgery remains confounded with complications which must be recognised by gastroenterologist and surgeon alike. This review looks to provide a contemporary outline of the history, indications, and complications of ileal pouch surgery.