Review Open Access
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, 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
ORCID number: Kheng-Seong Ng (0000-0002-7614-855X); Simon Joseph Gonsalves (0000-0001-5456-9436); Peter Michael Sagar (0000-0002-1242-5044).
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.

Key Words: 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.


As the ileal-anal pouch procedure celebrated its 40th anniversary in 2018, a review of the history of the pelvic ileal reservoir procedure, and its indications and complications, is timely and relevant.


The first reported case of the anastomosis of ileum to the anal sphincter complex was presented by Rudolph Nissen to the Berlin Surgical Society in April 1933[1]. This case appears to have involved the construction of a double-barrelled loop of ileum that was anastomosed to the anal sphincter complex by means of a combined abdominal and sacral approach. The end result was not successful.

Between 1941 and 1946, R Russell Best in Omaha, NE, United States, carried out nine procedures that he labelled as ileoproctostomies, stating explicitly that the anastomosis was between the ileum and the anus, thus differentiating this from an ileorectostomy in which ileum would be anastomosed to the rectum. Best stated that “any anastomosis 2.5 cm or more above the mucocutaneous line should be classified as an ileoproctostomy”[2]. His first report of the procedure was not optimistic because of the accompanying complications, but Best felt that improvements in technique would alter the evaluation of the procedure.

In 1947, Ravitch and Sabiston[3], following a series of experiments on animals, suggested anastomosis of ileum to the anus by a modified pull-through technique with the entire colon and terminal ileum exteriorised through the anus, after which the ileum was sutured to the anal sphincter mechanism. By 1951, Ravitch had carried out this procedure in 13 patients. In Philadelphia, PA (1952), Valiente and Bacon returned to Nissen’s premise of the use of loops of ileum as a functional reservoir and constructed a three-loop pouch with an efferent spout that was sutured to the anal sphincter. He performed this experimental series in seven dogs[4]. The authors concluded that, although sadly five of the dogs died, the result from two of the dogs were satisfactory - preservation of anal sphincter control in its entirety and a gradual change in the consistency of stool from mushy to formed. They observed that perianal irritation was minimal.

Interestingly, subsequent to this, the concept of the ileal reservoir was moved out of the pelvis and onto the abdominal wall by the work of Nils Kock in Gothenberg, Sweden (Figure 1A). The seminal paper was produced in 1969[5] and by the 1970s many patients were being offered a continent ileostomy. When it worked well, the continent ileostomy significantly improved the quality of life of the patient, but was frequently associated with complications, particularly slippage of the nipple valve; in this instance the patient would often require multiple revision procedures.

Figure 1
Figure 1 History of the ileal pouch. A: The Kock continent ileostomy; B: Common pouch configurations used in ileal pouches.

The great evolution in pouch surgery was heralded in 1978 when Sir Alan Parks and Mr John Nicholls effectively combined the idea of a three-limbed ileal reservoir with ileo–anal anastomosis. With this advance, Parks and Nicholls are credited as the first to describe the ileal pouch anal anastomosis (IPAA), having fashioned the S-shaped pouch for patients with ulcerative colitis (UC) after proctocolectomy. Their original description included a mucosectomy followed by a hand-sewn anastomosis between pouch and anus[6].

Since then, much has progressed in the surgical approach to pouch formation. For example, most surgeons nowadays favour a J-shaped pouch (Figure 1B), first described in 1980 by Utsunomiya et al[7]. This preference for a J-pouch is supported by a meta-analysis which demonstrated its superior function over S- or W-pouch configurations[8]. The J-pouch also confers an excellent long-term quality of life, and is easier to construct[9]. There has also been progression in the way the anastomosis is fashioned, with most contemporary surgeons favouring a stapled rather than hand-sewn anastomosis. While hand-sewn anastomoses permit mucosectomy (i.e., removal of a potentially diseased rectal cuff), any benefit from this seems offset by risk of damage to the anal sphincter and anal transition zone (ATZ), which is an important sensory rich area of the anal canal that allows flatus/stool discrimination[10]. A stapled IPAA, on the other hand, avoids a mucosectomy and is quicker to perform[11]. Moreover, it would appear that a stapled IPAA offers patients a better functional outcome with lower incidence of incontinence and nocturnal seepage[12], justifying the preference of surgeons towards a stapled IPAA.

Finally, the past decade has seen great advancement in the use of innovative surgical technology for pouch surgery. While laparoscopic approaches for IPAA have been described since the 1990s and have been demonstrated to be feasible and safe[13], surgical techniques have progressed rapidly to robot-assisted techniques[14,15], single incision laparoscopic surgery (SILS)[16], transanal proctectomy (TaTME)[17], and natural orifice specimen extraction[18]. These new techniques promise to improve surgical accuracy, postoperative recovery, and postoperative pain, and while studies exist to demonstrate their feasibility[19], robust data regarding their efficacy in pouch surgery is awaited[20].

Despite such modifications in surgical technique over the past 40 years, IPAA remains a high-risk operation, with a recent push towards centralisation of this operation to high volume centres[21,22]. IPAA is accompanied by complications that challenge the surgeon and gastroenterologist alike, and have far-reaching consequences for the patient. The subsequent sections of this review look to provide an up-to-date appraisal of indications (and contraindications) to IPAA surgery, and outline common postoperative complications and their management.


Restorative proctocolectomy (RPC) with an IPAA is the procedure of choice for a variety of pathologies, including: UC; classic familial adenomatous polyposis (FAP); and other polyposis syndromes or conditions with multiple synchronous cancers involving the rectum. In one meta-analysis of over 9000 patients undergoing IPAA, the indications for surgery were: UC (87.5%); indeterminate colitis (IC) (2%); Crohn’s disease (0.8%); FAP (8.9%); and other diagnoses (0.7%)[23]. For all indications, though, the aim of RPC/IPAA remains the same: To definitively cure disease and prevent malignant degeneration, while providing adequate continence and avoiding a permanent stoma[24].

Ulcerative colitis

UC is a chronic inflammatory disease of the colon and rectum. Surgery for UC is indicated in five instances: (1) Acute colitis unresponsive to medical therapy; (2) Disease which is later refractory to medical treatment; (3) Patients who fail to tolerate medical treatment or its adverse effects, including steroid-dependent disease; (4) Cases of neoplastic or dysplastic transformation of the intestinal mucosa; and (5) In the paediatric setting where there is failure to thrive.

Previous studies have estimated that approximately one-third of patients with UC will succumb at some point to surgery[25,26]. However, contemporary studies demonstrate that colectomy rates for UC are decreasing, probably due to improvements in medical rescue therapies[27,28]. In fact, a recent population-based cohort study observed 5-, 10-, 15-, and 20-year cumulative colectomy rates after diagnosis of 4.1%, 6.4%, 10.4%, and 14.4%, respectively[29]. There are a number of surgical options available to UC patients. Conventional proctocolectomy involves removal of the colon and rectum and immediate formation of a permanent end ileostomy[30]. While early studies suggested that patients adapt to their ileostomy[31,32], other studies have described psycho-social problems as a result of stoma formation[33,34]. Cli-nicians have therefore sought procedures that avoid the need for a permanent ileostomy. Herein lies an important point, that in a sense, the sole indication for a RPC (i.e., with IPAA) is the desire to avoid a permanent ileostomy. Nevertheless, such has been the success with IPAA surgery that by as early as 1989, the procedure was considered the first choice elective operation for patients with UC[35].

There has been much debate in the timing of pouch surgery for UC patients. Most surgeons would agree that the timing is largely driven by the physiological/metabolic status of the patient and their existing immunosuppression[36]. Indeed, the majority of patients undergoing surgery for UC are on chronically high doses of immu-nomodulating agents (including steroids, azathioprine, biological therapy), which affect postoperative outcomes[37]. One study found that patients who received preoperative steroids were at higher risk of pouch-related sepsis[38], and moreover, patients taking higher steroid doses (> 40 mg) were at greater risk compared to those taking lower doses or no steroid at all. The conclusion of that study was to defer IPAA in favour of a non-restorative proctocolectomy or subtotal colectomy in patients receiving > 20 mg of steroid at the time of surgery, a finding which is in agreement with current European guidelines on pouch construction for UC patients[39].

Regarding anti-TNFα and anti-integrin agents, current Association of Coloproctology Great Britain and Ireland (ACPGBI) guidelines suggest that where clinical circumstances permit, these should be withheld for 14 to 30 d prior to elective surgery for UC[36]. Evidence on this topic, however, is poor. One meta-analysis demonstrated that pre-operative infliximab use increased the risk of short-term post-operative complications in UC patients[40], although studies specific to IPAA demonstrated no increased risk[41,42]. Several studies have failed to demonstrate an increased risk of infective complications with anti-integrin therapy[43,44], although one study demonstrated a strong trend towards more frequent intra-abdominal abscesses and mucocutaneous separation in pouch patients treated with vedolizumab compared with anti-TNFα agents[45]. The data regarding the peri-operative use of these agents in patients undergoing IPAA surgery thus remains inconclusive, and high-quality prospective trials are eagerly awaited.

Another point of controversy in IPAA surgery is with respect to the decision for temporary proximal diversion, which largely defines the difference between”one-“, “two-“, and “three-stage” pouch surgery. “One-stage” IPAA surgery refers to proctocolectomy and pouch formation without loop ileostomy; “two-stage” surgery refers to proctocolectomy and pouch formation with loop ileostomy followed by ileostomy reversal; and “three-stage” surgery is usually reserved for patients who present acutely with severe colitis where an initial subtotal colectomy is performed, followed by an interval completion proctectomy/IPAA and proximal diversion, thence followed by ileostomy reversal. In a survey of North American surgeons, 71% of the 575 surgeons reported that they would routinely choose to create a loop ileostomy[46]. The benefit of a temporary loop ileostomy appears logical in terms of avoiding pelvic sepsis; however, there is a paucity of evidence to demonstrate that proximal diversion improves outcomes after IPAA. Critics of proximal diversion would suggest that the risk of morbidity from their interim stoma and subsequent closure of their ileostomy would offset the benefits of diversion. Indeed, a high output ileostomy has been reported to affect approximately 10% of patients, often requiring early closure of their ileostomy[47]. Complications after closure of ileostomy are real, with postoperative morbidity reported to affect between 10 and 30% of patients[48-56].

There is a single small randomised trial that has sought to evaluate the outcomes of proximal diversion at the time of IPAA compared to a “one-stage” procedure[57]. Grobler et al[57] studied forty-five patients who were randomised to either a “one-“ or “two-stage” pouch procedure. All the patients were steroid naïve at the time of surgery. Patients were randomised to the trial after an uncomplicated IPAA and a negative intraoperative anastomotic leak test. The results did not show any difference in the rate of septic complications between the two groups. However, the translation of these findings should be interpreted with caution as the study was small and demonstrated significantly greater number of females in the “one-stage” group compared to the “two-stage” group. The effect of this observed gender difference might have biased results, as it is perceived that pelvic dissection is often easier in females and therefore the subsequent risks of pelvic sepsis may be reduced compared to the narrow android pelvis of males. This study inadvertently highlights that patient selection is of great importance when considering a “one-stage” procedure.

A meta-analysis performed by Weston-Petrides et al[58] reviewed the literature, comparing the outcomes of RPC with and without ileostomy at a minimum follow-up of 12 mo. The analysis reviewed 1486 patients across 17 studies. 721 of these patients received a diverting ileostomy whilst the remaining 765 did not. The analysis found that the overall incidence of anastomotic leakage and pouch related sepsis was 7%. This was greatest in the group without ileostomy (odds ratio 2.37, 95% confidence interval 1.39-4.04, P = 0.002). There was no significant difference in the incidence of small bowel obstruction (SBO) between the two groups, and there was also no difference in the incidence of pouchitis between the two groups. It would appear, therefore, that meta-analysis supports the use of a routine diverting ileostomy, demonstrating improved short-term outcomes over that of the “one-stage” procedure.

Familial adenomatous polyposis

Classical FAP is a syndrome characterised by hundreds (and often thousands) of adenomatous polyps in the colon and rectum at a young age (usually by the third decade of life). It is a genetic condition based on a mutation in the adenomatous polyposis coli (APC) gene. There is a push nowadays for all at-risk patients to undergo genetic testing that serves two purposes: (1) To provide a genetic basis to aid diagnosis of the syndrome; and (2) To allow genotype-phenotype correlation which helps predict the clinical manifestations of the syndrome and guide appropriate management. Specifically, the site of the mutation in the APC gene influences the expression of FAP, and can help distinguish between “severe” and “attenuated” FAP[59].

Without prophylactic colectomy, the risk of colorectal cancer in FAP patients is almost 100%[60]. Once a diagnosis of FAP is made, either by genetic testing or endoscopic detection of polyposis, the aim is to offer prophylactic surgery before cancer develops. In patients who are symptomatic, surgery is usually indicated as soon as practical[60,61]. In most cases, however, it is preferable to defer surgery until such a time when its impact on social functioning and educational activities will be minimised[62].

As surgical options have increased, so has the debate surrounding the choice between them. The available options are: (1) Colectomy and ileorectal anastomosis (IRA); (2) RPC/IPAA; and (3) Non-restorative proctocolectomy. While proctocolectomy is considered by some to be routine choice for all FAP patients, this approach has been questioned of late[63], as it is increasingly recognised that selected patients with FAP may do better with a colectomy/IRA instead[59]. This is because in selected cases, the risk of developing rectal cancer is low, and the decision for colectomy/IRA is reasonable so long as rectal surveillance can be assured. This is relevant because functional outcomes in terms of bowel frequency and incontinence are more favourable with IRA than IPAA, and sexual and reproductive function can be adversely impacted with proctectomy. These are pertinent considerations for typically young patients who are otherwise healthy, and who are undergoing surgery for prophylaxis rather than treatment[60].

The decision for RPC/IPAA as opposed to colectomy/IRA therefore appears largely driven by the underlying genotype-phenotype correlation. For example, polyp burden has been demonstrated to predict future proctectomy risk. One study by Church et al[64] followed 94 patients with < 5 rectal adenomas and < 1000 colonic polyps who underwent IRA; after a median of 12 years, no patient required secondary proctectomy. Conversely, over one-third of 74 patients who had > 20 rectal polyps and underwent an IRA required interval proctectomy. Proctoscopic findings of < 5 rectal adenomas almost always correlates with mild disease, and in such cases, an IRA appears a reasonable surgical option[63].

APC genotyping can also aid in the surgical planning for FAP patients. The two genotypes that predict need for future proctectomy are: (1) Codon 1309 mutation; and (2) Codon 1328 mutation[65]. Patients carrying these mutations should have a RPC[61]. In the absence of these mutations, and in patients with: (1) No rectal cancer or advanced rectal neoplasia (e.g., large or high-grade tubulovillous adenoma); (2) Low polyp burden in the rectum (< 20 adenomas); and (3) No colon cancer or profuse colonic polyposis, a rectal sparing colectomy/IRA should be considered as a reasonable alternative[63]. Importantly, however, for rectal sparing surgery to be recommended, a rigorous rectal surveillance program must be adhered to, and if such a program seems impossible, an IPAA should be recommended, irrespective of the polyp burden or genetic profile of the syndrome[24].


Contraindications to RPC/IPAA can be broadly classified as absolute and relative. Absolute contraindications include: (1) An incompetent anal sphincter mechanism[66]; (2) Emergency presentation with accompanying use of high-dose steroid[67]; and (3) Carcinoma of the low rectum requiring complete excision of the anorectum. Relative contraindications to RPC/IPAA include: (1) Crohn’s disease; (2) IC; and (3) Primary sclerosing cholangitis (PSC). These contraindications are relative as they are associated with a higher incidence of postoperative morbidity and pouch failure.

Formation of an IPAA for Crohn’s disease is generally contraindicated[66]. However, it continues to be performed, often inadvertently. In some cases where there is difficulty distinguishing between UC and Crohn’s, the patient’s histology is described as “indeterminate”, although a subsequent diagnosis of Crohn’s disease will be made in up to 15%[68]. Patients with IC or Crohn’s disease exhibit a higher incidence of pouch failure compared to those with UC, with the incidence of pouch failure in this cohort ranging from 20% to 60%[69-71]. Contentiously, pouch failure rates as low as 10% have been published in Crohn’s patients[72]. These studies, however, strictly selected patients whose inflammation was limited to the large bowel, and who had no small bowel or anoperineal disease. On this basis, current European Crohn’s and Colitis/European Society of Coloproctology guidelines state that in carefully selected Crohn’s patients with no history of perianal or small bowel disease, RPC/IPAA can be offered with expectation for a comparable quality of life to those with UC[73]. Generally speaking though, IPAA surgery in Crohn’s patients is still treated with caution, and most clinicians would seek to avoid restorative surgery in patients with confirmed or suspected Crohn’s disease[74].

By contrast, the majority of patients with IC are known to benefit from RPC/IPAA, although their risks of pouch failure are slightly higher than those with UC. One study showed that 27% of IC patients suffered from pouch failure compared to 11% in the UC group[68]. The higher rate in the IC group was largely attributed to the diagnostic conversion of 15% to Crohn’s disease, with sub-analysis indicating that patients with true IC have a similar failure rate to those with UC. It would therefore appear that patients with IC are suitable candidates for pouch surgery[24], but should receive appropriate counselling of the surgical risks and the implications of subsequent conversion to Crohn’s disease.

PSC is a chronic cholestatic liver disease of unknown aetiology, and is viewed as a relative contraindication to pouch surgery because of the increased risk of pouchitis (almost double that of the normal pouch population)[75-78]. Patients with PSC also exhibit high levels of perinuclear antineutrophilic cytoplasmic antibodies (p-ANCA). One study found that patients with UC who displayed high levels of p-ANCA prior to IPAA were more likely to develop pouchitis within 12 months of surgery compared to those who were p-ANCA negative (100% vs 56%)[79]. It has been postulated that preoperative p-ANCA levels may help to identify patients at risk of developing pouchitis[80], although this is not a widely adopted approach.


There are two concepts that relate to the achievement of a “good” quality of life for IPAA patients. The first and fundamental concept relates to the removal of disease burden. The second relates to the avoidance of a permanent stoma.

Kohler et al[81] compared the quality of life of patients after the various types of surgery for UC. The study evaluated three groups of surgical patients: Conventional proctocolectomy with end ileostomy (406 patients), Kock continent pouch (313 patients) and IPAA (298 patients). The study demonstrated that quality of life was greatest in those patients that received an IPAA and least in those with an end ileostomy. Pemberton et al[82] performed a prospective cohort study to evaluate and compare the functional outcomes and quality of life of 406 patients who had undergone an abdominal proctocolectomy and Brooke ileostomy between 1966 and 1980 and 298 patients who underwent an IPAA between 1981 and 1988. The study demonstrated comparable satisfaction levels between both groups. However, the performance status (activity) of patients with an IPAA was greater than those with an ileostomy. These findings also translated to the patient’s sexual functioning, with 30% of ileostomy patients reporting limited sexual functioning compared to 13% of patients in the IPAA group. The authors report that the majority of ileostomy patients were satisfied with their treatment, although 39% stated that they would desire a change from their current situation with a view to an alternative surgical option. From these two studies, it would appear that, despite removal of disease burden, the avoidance of a stoma remains of great importance to patients.

That said, it is interesting to note the disparity in quality of life outcomes following pouch surgery for FAP as opposed to UC. In keeping with UC patients, FAP patients are typically young. However, unlike the majority of patients with UC, FAP patients are often asymptomatic at the time of presentation. Heuschen et al[83] performed a prospective study of 34 patients (27 patients with UC and 7 with FAP). They aimed to compare the quality of life of patients before and after RPC, and again 1-year after closure of their ileostomy. They found that the patients’ quality of life was significantly improved in the UC group after surgery. However, the converse was observed in patients with polyposis. Even after reversal of their ileostomy only a part improvement in their scores was observed. It would appear that patients with UC are sensitive to an improvement from their surgery owing to the removal of their disease burden. In comparison, patients with FAP, who are often asymptomatic at the time of their surgery, did not derive as obvious a benefit. This was reflected in their poorer scores. This studies’ findings, which contrasts somewhat to that of Kohler et al[81] and Pemberton et al[82], would suggest that removal of disease burden, rather than restoration of intestinal continuity, is the major determinant in providing a better quality of life for the surgical patient.


The mortality rate for RPC/IPAA is low. Studies describe the rate to be between 0.2% to 1.5%[22,84]. This low mortality rate is largely because patients are typically young, healthy, and fit for major surgery. Further, operations are generally performed in tertiary centres on well-selected patients who have undergone appropriate pre-operative workup and counselling[85].

In distinct contrast to mortality, the IPAA procedure does have an appreciable morbidity which patients should be aware of before choosing the procedure. Early studies reported the incidence of major complications to be as high as 54%, but this has decreased to 19% in contemporary literature as experience in this surgery has increased[85]. A meta-analysis reported the most common pouch-specific complications following IPAA to be: Pouchitis (18.8%), pelvic sepsis (9.5%), stricture (9.2%), and fistula (5.5%)[23]. Morbidity following IPAA is traditionally classified into those which are “early” (within 30 d of surgery) or “late” (usually following closure of ileostomy) (Table 1).

Table 1 Complications following ileal pouch anal anastomosis.
Complications following IPAA
Staple line bleeding
Pouch ischaemia
Intraabdominal bleeding
Intramural haematoma
Acute pelvic sepsis
Anastomotic leak
Infected haematoma
Portal vein thrombus
Chronic pelvic sepsis
Pouch fistulae (pouch-vaginal, pouch-anal, pouch perineal)
Small bowel obstruction
Pouch dysfunction
Mechanical causes (obstruction/ pouch stricture, poor compliance)
Irritable pouch syndrome
Pouch failure
Cuff dysplasia
Pouch dysplasia
Early post-operative complications

In the early postoperative period the main complications include haemorrhage, acute pelvic sepsis, and portal vein thrombus.

Haemorrhage: Postoperative haemorrhage may be either reactionary or delayed, and is usually related to the pouch staple line. It occurs in approximately 4% of patients following pouch surgery[86]. Following anastomosis, the pouch should be examined for any bleeding points, and if found, under-run. Persistent bleeding in the first 24 h requires examination under anaesthesia[87]. In some cases, pouch endoscopy may be required, during which clots are evacuated and the pouch irrigated with adrenaline solution[88]; occasionally, a single point of bleeding may be seen and under-run with a suture[87].

Less commonly, postoperative haemorrhage may be due to pouch ischaemia. The distinction is usually easy to make, as suture line bleeding is bright in colour, whilst blood from pouch ischaemia is darker red with clots[85]. Intra-abdominal bleeding that does not directly originate from the pouch may be from the colonic bed, the lateral pelvic walls, and/or the mesenteric vessels[87]. Finally, intramural hematoma of the pouch is a rare complication that can lead to pouch fibrosis and longer-term pouch dysfunction, due to development of a stiff non-compliant pouch[89]. In extreme circumstances, an intramural haematoma may be a prelude to an anastomotic leak; the patient should be commenced on broad-spectrum antibiotics, and a catheter should be carefully placed transanally to effect adequate pouch decompression[87].

Acute sepsis: Evidence of acute sepsis in the early postoperative period should arouse suspicion of evolving pelvic sepsis. Early pelvic sepsis usually presents with fever, anal pain, tenesmus, and/or purulent discharge per anus. Alertness to this common postoperative complication is essential. Diagnosis is confirmed with cross-sectional imaging by computed tomography or magnetic resonance imaging, which may demonstrate an abscess or oedematous tissue planes.

Pelvic sepsis usually occurs as a result of an anastomotic dehiscence or the presence of an infected haematoma. Because patients who develop early pouch sepsis have a higher risk of subsequent pouch dysfunction and failure[90], an aggressive management approach is required. Prompt treatment maximises the chances of pouch preservation, whereas delayed therapy results in a stiff, non-compliant reservoir. Most patients respond to intravenous antibiotics, but patients with ongoing sepsis and an organised abscess should undergo early drainage, either transanally or by a radiology-guided percutaneous approach. If possible (and appropriate), a transanal approach is usually preferred, during which a Depezer or Malecot catheter is placed through the anastomosis to drain peripouch collections/abscesses[87]. Due to the potential risk of fistulation along the drain tract, trans-gluteal drainage should be avoided if possible[91].

If drainage of the cavity is inadequate with these measures, the abscess should be deroofed and the cavity curetted through the anus, thereby upsizing the communication between abscess and pouch. Several attempts may be needed to eradicate sepsis. Recently, endo-cavitational vacuum therapy (Endo-SPONGE®) has been embraced for the treatment of low pelvic leaks (Figure 2); first described for the treatment of anastomotic leak following anterior resection[92], its use has been borrowed for the treatment of anastomotic dehiscence post-IPAA, with encouraging results[91]. Rarely, an abdominal approach (re-laparotomy) is needed. If anastomotic dehiscence is recognised pre-ileostomy closure, ileostomy closure should be delayed until clinical and radiographic evidence of healing is achieved.

Figure 2
Figure 2 Endo-cavitational vacuum therapy (Endo-SPONGE®). A: Endoscopic view of a pouch with a cavity (arrow) at the anastomosis secondary to anastomotic leak. The true lumen is at the inferior aspect; B: Contents of the Endo-SPONGE® kit (B Braun Medical Ltd); C: The foam of the Endo-SPONGE® is passed into the cavity and negative pressure applied to collapse the cavity.

Portal vein thrombus: An association between portal vein thrombosis and inflammatory bowel disease (IBD) has been established[93,94]. Factors contributing to portal vein thrombosis following pouch surgery include the hypercoagulable state of IBD patients, the inflammatory response secondary to pouchitis/sepsis, and dehydration due to a high output stoma/pouch. Other factors include the need to mobilise small bowel mesentery to its root, which can potentially result in endothelial stretch and injury and a subsequent thrombotic cascade[95].

Portal vein thrombi have been documented to occur in up to 45% of patients following RPC/IPAA who undergo postoperative imaging[93]. This, of course, is a biased finding, as the proportion of patients with portal vein thrombi who do not undergo postoperative imaging is unknown. Most portal vein thrombi are asymptomatic, but may cause symptoms of abdominal pain, fever, nausea, or vomiting[87]. Thrombi are treated with anticoagulation for 3-6 months. Interestingly, with appropriate management, portal venous thrombi appear to have minimal impact on long-term pouch function or quality of life[96], although potential sequalae, such as portal hypertension and gastric varices, have not been thoroughly investigated[97].

Late post-operative complications

Chronic pelvic sepsis: Chronic pelvic sepsis is estimated to complicate 10%-20 % of IPAAs. This phenomenon may manifest in a number of ways, which include: (1) Pouch fistulae (pouch-anal, pouch-vaginal, pouch-perineal); (2) Anastomotic stricture; and (3) Poor pouch compliance with resultant poor function.

The reported incidence of pouch-vaginal fistula ranges from 7% to 10%[98,99]. Pouch-vaginal fistulae usually present with persistently abnormal (enteric) vaginal discharge, and diagnosis is confirmed by an examination under anaesthetic which demonstrates the fistula (Figure 3). Occasionally, a radiological contrast enema (pouchogram) is required to clinch the diagnosis. Importantly, a pouch-vaginal fistula should be excluded prior to ileostomy closure by careful examination of the vagina and anal canal[98]. Causative factors of pouch-vaginal fistulae include inadvertent injury to the vagina during rectal dissection, and anastomotic dehiscence with subsequent pelvic sepsis[100].

Figure 3
Figure 3 Examination under anaesthesia performed for a female patient who presented with perineal sepsis and abnormal per vaginal discharge following ileal pouch anal anastomosis. A pouch-vaginal fistula was identified and confirmed with a probe.

Management of pouch fistulae depends on the severity of symptoms. When symptoms are minimal, placement of a seton may be all that is required. In those with incontinence, proximal diversion with an ileostomy should be performed if not already present. At the time of de-functioning, sepsis should be adequately drained (with or without placement of a seton). Fistula repair can then be embarked upon when control of sepsis is achieved. Simple de-functioning alone does not usually lead to fistula closure[101].

Surgical options of pouch fistula repair are divided into abdominal and perineal procedures. Abdominal procedures include pouch revision with advancement of the ileoanal anastomosis. Perineal approaches include fistulectomy with or without sphincter repair, endoanal advancement flaps, or even transvaginal pouch repair. The height of the anastomosis is the critical determinant of the chosen operative approach: (1) Pouch-vaginal fistulae from an anastomosis at or above the anorectal junction should be approached abdominally with pouch dissection, repair of the vaginal defect, and refashioning of a new anastomosis[101,102]; while (2) A fistula arising from an anastomosis within the anal canal should not be treated with an abdominal procedure as there is insufficient anal canal length distally for re-anastomosis. A perineal approach is required in such circumstances, either by an advancement flap[98-100,103] or transvaginal technique[100,104,105].

Small bowel obstruction: SBO occurs in up to 30% of patients over 10 years, and can result from adhesions that form to the raw surfaces after colectomy and/or kinking at the ileostomy. Patients who undergo IPAA are at particularly high risk for SBO because of the extensive abdominal and pelvic dissection incurred during pouch surgery, the need for multiple (staged) operations, and a possibly higher septic complication rate compared with less complex procedures. In one study by MacLean et al[106], the cumulative risk of SBO was found to be 9% at 30 d, 18% at 1 year, 27% at 5 years, and 31% at 10 years. The need for surgical intervention for SBO was 1% at 30 days, 3% at 1 year, 7% at 5 years, and 8% at 10 years. It would appear, therefore, that while the risk of SBO after IPAA is high, most cases can be successfully managed without surgery.

Important factors predictive of SBO include use of a diverting ileostomy, stomal rotation 180° (as some authors advocated to reduce faecal spillage into the de-functioned pouch)[107], and need for pouch reconstruction[106]. Internal herniation, possibly even under the pouch mesentery, should not be forgotten as a potential cause of (usually early) SBO[108]. Intuitively, a lower incidence of SBO may be expected following laparoscopic pouch surgery due to a reduction in adhesion formation. This, however, is not supported by existing data, with one meta-analysis failing to demonstrate any difference in adverse event rates and long-term functional outcomes between open and laparoscopic pouch surgery[13]. In fact, with a totally laparoscopic approach, it has been argued that a 180° degree twist in the pouch can be readily missed; the resulting pouch “volvulus” has been known to cause SBO, noted only following closure of ileostomy (Figure 4).

Figure 4
Figure 4 A coronal computed tomography image of a patient who presented with early small bowel obstruction following closure of ileostomy (6 mo post pouch creation). Computed tomography and operative findings confirmed small bowel obstruction secondary to a 360° twist at the level of the anastomosis.

Pouch dysfunction: Michelassi et al[109] performed a large prospective observational study of 391 patients with an IPAA. This seminal study reported the long-term functional outcomes of patients at a median follow-up of 34 (range 0 to 180) months. Based on the results of this study, which are in agreement with others performed on separate (and indeed, larger) cohorts[110,111], “normal” pouch function is usually defined by a 24-h stool frequency of four to eight motions per day with one nocturnal motion, and the ability to defer pouch evacuation until convenient[109]. Poor pouch function is therefore defined by deviation of the patient’s median stool frequency from the normal, and/or an inability of the patient to maintain both diurnal and nocturnal continence.

The issue of pouch dysfunction is particularly important given its critical influence on patients’ quality of life following surgery. While studies that have evaluated quality of life in the context of IPAA surgery have generally described the procedure as offering a “good” quality of life[112], this demonstrates close correlation with measured pouch function. For example, Tiainen et al[113] demonstrated that patients who exhibited good postoperative pouch function, had a quality of life comparable to that of healthy controls; in contrast, patients with poorer function (i.e., frequent episodes of faecal incontinence and urgency) had a significantly poorer quality of life. There are a number of causes of poor function of the pouch, which can be categorised as: Mechanical; inflammatory (cuffitis, pouchitis); and septic (discussed above).

Mechanical causes of poor function of the pouch include: A small volume pouch, a poorly compliant pouch, a weak sphincteric complex, and pouch outflow obstruction. It is recognised that the manovolumetric characteristics of the pouch are linked to its resultant function[114,115]. A small, non-compliant pouch will promote faecal urgency and increased frequency[116]. A poor-quality sphincter complex with a weak-resting pressure can cause frequent small volume incontinence. Obstruction to pouch outflow usually occurs at the level of the anastomosis (Figure 5). Anastomotic stricture is estimated to affect 14% of pouch patients[86], and are usually related to a local complication such as undue tension of the anastomosis and local ischaemia (with or without subsequent anastomotic leakage). Full mobilisation of the mesentery to minimise traction on the reservoir is an important manoeuvre to avoid stricture formation. Interestingly, recent studies have demonstrated lower rates of stricture following stapled rather than hand-sewn anastomoses[117-120]. Web-like strictures can be easily broken with gentle passage of a finger, but such flimsy strictures rarely cause significant symptoms. More fibrotic strictures may also be fractured digitally but often require the insertion of graded dilators (bougie or Hegar) under anaesthesia[121]. On occasion, repeated dilatations are required, yet reasonable function can be expected in more than one-half of patients[104,122,123]. Some patients may require self-dilatation with an anal dilator on a daily basis, a practice that is usually well-tolerated by patients. The aim is to achieve a stable lumen diameter that admits an index finger to the level of the proximal interphalangeal joint, as this seems to correlate with reasonable function[87]. The longer the stricture, though, the less likely it is to yield to simple dilatation, and rarely, a transanal approach involving excision of the stricture and pouch advancement is required[124].

Figure 5
Figure 5 Obstruction to pouch outflow usually occurs at the level of the anastomosis. A: A coronal computed tomography image demonstrating a pouch outlet stricture. A stricture at the level of the anastomosis (arrow) caused a dilated pouch that could not empty without intubation; B: A pouchogram of the same patient confirmed an anastomotic stricture that eventually yielded to serial Hegar dilations.

Cuffitis is an inflammatory condition of the residual rectal cuff, and may be related to the anastomosis being fashioned to the rectum rather than to the top of the anal canal (essentially an ileal pouch–rectostomy)[87]. Such an anastomosis therefore incorporates rectal tissue, which in UC patients poses risk of recrudescence of inflammation at the anastomosis[125]. Proponents of hand-sewn anastomoses would argue this condition occurs less with their anastomoses given a mucosectomy is routinely performed. Interestingly, the advent of laparoscopic pouch formation has been associated with an increase in patients coming to re-do surgery for long retained rectal cuff[126]; this is probably because cross-stapling of the anal stump remains challenging with current laparoscopic staplers and inadvertent proximal stapling of the distal rectum occurs instead. Cuffitis may respond to topical steroids, suppositories or 5-aminosalicylic acid preparations. In cases that prove resistant, the residual mucosa can be dissected off via a perineal approach, and mucosectomy is carried out from the dentate line to the anastomosis. The anastomosis is then disconnected circumferentially to permit delivery of the pouch down to the level of the anal verge. A new anastomosis is made with interrupted sutures[87].

Pouchitis is the most common complication associated with the IPAA, affecting 44% of patients at 10-year follow-up[127]. It is characterised clinically by the presence of crampy lower abdominal pain, general malaise, and increased stool frequency, often with the presence of bloody stools[128-130]. Studies suggest that pouchitis is most likely to occur within the first year after construction of the pouch[131], with the first episode typically occurring shortly after reversal of the ileostomy[132]. The time course of the condition varies from patient to patient, and may be classified into two distinct entities: acute pouchitis and chronic relapsing pouchitis. The aetiology of pouchitis remains unclear, but it is interesting to note that pouchitis does not appear to affect pouches formed for FAP[133]. The diagnosis of pouchitis requires a combined evaluation of clinical symptoms, endoscopic assessment of the pouch (Figure 6), and histopathology from pouch biopsies. A variety of scoring systems have been described to assess the severity of pouchitis[67,134-136], the best known of which is the pouch disease activity index[135] (Table 2). The treatment of pouchitis focuses on correction of a perceived bacterial dysbiosis[137], and patients are commonly prescribed ciprofloxacin or metronidazole[138-141]. Studies suggest that both antibiotic regimes are effective, but ciprofloxacin is usually better tolerated than metronidazole. Therefore, ciprofloxacin has largely become the antibiotic of choice. Some cases of pouchitis are refractory to antibiotics alone though. Recent reports have suggested that altering the pouch flora with probiotic bacteria may be an alternative or adjunct to antibiotic use[142-144], especially in patients with chronic pouchitis. Two probiotic agents have been studied in the context of pouchitis: VSL#3® and Lactobacillus rhamnosus GG. Randomised studies have identified that VSL#3® confers a remission rate of 85% over a median follow-up of 9[142] and 12 mo[143]. In patients with pouchitis refractory to antibiotic and probiotic therapy, other disease modifying drugs have been tried, with varying success. Recent reports have shown infliximab to be effective in the treatment of chronic pouchitis complicated by fistulous disease[145,146], although in a recent meta-analysis, anti-TNF agents appear to have most efficacy in Crohn’s disease-like complications of the pouch rather than true refractory pouchitis[147]. Topical or oral mesalazine may also be of benefit in pouchitis[148], but 5-aminosalicylate therapy seems to have a greater role in the treatment of cuffitis rather than pouchitis[125]. Finally, while the prescription of steroids seems intuitive, there is a lack of evidence to support its use in pouchitis, either in oral or enema form.

Table 2 The pouch disease activity index.
I Clinical
1 Stool frequency(0, 1, 2)
2 Faecal urgency/Abdominal cramps(0, 1, 2)
3 Rectal bleeding(0, 1)
4 Fever > 37.8 °C(0, 1)
Maximal clinical sub-score: 6
II Endoscopic finding
1 Oedema(0, 1)
2 Granularity(0, 1)
3 Friability(0, 1)
4 Loss of vascular pattern(0, 1)
5 Mucous exudates(0, 1)
6 Ulcerations(0, 1)
Maximal endoscopic sub-score: 6
III Histology-acute histological inflammation
1 Polymorphonuclear infiltration(0, 1, 2, 3)
2 Ulceration per low power field (mean)(0, 1, 2, 3)
Maximal histological sub-score: 6
Maximal total PDAI: 18
Figure 6
Figure 6 Endoscopic view of pouchitis (Pouch Disease Activity Index endoscopic sub-score 4).

Pouch failure: Pouch failure can be defined as the need for pouch excision or an indefinite defunctioning ileostomy. Early pouch failure is usually associated with pelvic sepsis, while later failure is related to pouch dysfunction or Crohn’s ‘conversion’[149]. The rate of pouch failure is between 5%-10%[150].

Much work has gone into predicting risk of pouch failure in individual patients. In an ileal pouch failure model[151] [often referred to as the Cleveland Clinic Foundation (CCF) ileal pouch failure score], patient diagnosis, prior anal pathology, abnormal anal manometry, patient comorbidity, pouch-perineal or pouch-vaginal fistula, presence of pelvic sepsis, and anastomotic stricture and separation were identified as independent predictors of pouch survival. The CCF pouch failure score is presented in Table 3, and remains a simple and accurate tool to predict the risk of pouch failure in clinical practice. Interestingly, the CCF pouch failure model does not identify pouchitis to be an independent risk factor, but the model is in keeping with findings of previous studies which have highlighted pelvic sepsis as a clear risk factor for poor pouch function[90,152].

Table 3 The Cleveland Clinic Foundation ileal pouch failure score.
Risk factorPoints
UC or indeterminate colitis1
Crohn’s disease1.5
Patient co-morbidity
No comorbid conditions0
1 comorbid condition0.5
2 or more comorbid conditions1
Prior anal pathology
No prior anal pathology0
Prior anal pathology1
Anal sphincter manometry
Normal manometry0
Abnormal manometry (squeeze pressure < 100, resting pressure < 40)1
Anastomotic separation
No anastomotic separation0
Anastomotic separation1
Anastomotic stricture
No stricture or asymptomatic stricture0
Symptomatic stricture1
Pelvic sepsis
No sepsis0
One episode of pelvic sepsis1
Two or more episodes of pelvic sepsis2
Fistula formation
No fistula0
Pouch-perineal fistula1
Pouch-vaginal fistula2
TOTAL score

Traditionally, pouch excision is the recommended management for the failed pouch, especially in patients for whom restoration of intestinal continuity is not pursued[152,153]. Such surgery is not without its burden though. In one study of patients undergoing pouch excision, 57% experienced short-term postoperative complications (most commonly a surgical site infection); 37% had long-term complications (most commonly perineal wound issues)[154]. In fact, persistent perineal sinus following pouch excision has been associated with Crohn’s disease, perineal dissection which leaves the external sphincter intact, chronic pelvis sepsis, and smoking, and may require formal sinus excision and transposition flap if unhealed with conservative measures[36].

Permanent ileostomy without pouch excision remains the obvious alternative. Moreover, favourable outcomes have been described following salvage surgery for pouch failure, including transanal pouch mobilisation/advancement, resection of an elongated pouch efferent limb, and re-do pouch surgery[103,155-162]. It should be borne in mind, however, that re-do pouch surgeries are complex procedures, performed infrequently, with most existing data based on retrospective series and heterogeneous groups of patients and their complications. A systematic review of salvage surgery after IPAA reported complications in almost one-half, a 74% “success rate” and an eventual 18% pouch excision rate after re-do pouch surgery[126]. Patients pursuing re-do pouch surgery should also be aware that functional outcomes after re-do surgery are inferior to those following “primary” IPAA formation, with higher rates of bowel frequency, urgency, and incontinence reported[36].

Finally, with the complexities of pouch excision and revisional surgery recognised, and with studies establishing a clear volume-outcome relationship in several aspects of IBD management[163], there has been a distinct push towards centralising the management of the failing pouch to higher volume centres. Patients with complications of pouch surgery including anastomotic leak and chronic pelvic sepsis are likely to achieve better outcomes if they are referred to a specialist centre with appropriate experience in managing such complications. Such observations have led to the ACPGBI consensus statement that appropriate referral to a sub-specialist unit should be considered for all IBD patients with complex or recurrent disease, including those requiring revision and excision pouch surgery[36]. Intuitively, this is related to the concentration of institutional experience in higher-volume centres when managing such specialised cases.

Dysplasia and malignancy: Initially, RPC/IPAA was thought to remove all tissue at risk of disease from UC and FAP, thus obviating the need for follow-up and removing the future risk of malignancy. However, dysplasia and cancer can still occur in the rectal cuff (or ATZ) and ileal pouch mucosa in both UC and FAP patients. The pathophysiology of dysplasia is completely different in these two diseases, though. In UC, persistent inflammation is the most important factor in progression to dysplasia, whilst in FAP, residual rectal and/or small bowel mucosa may undergo dysplastic change due to underlying genetic alterations associated with the disease; in-flammation thus plays no part in this process[164].

The problem of cuff dysplasia relates to retention of islets of rectal mucosa, which inevitably occurs with a stapled anastomosis. Cuff dysplasia is a rare event though[165,166], and any retained rectal mucosa usually causes more problems with cuffitis than dysplasia. It should also be noted that patients with mucosectomy and hand-sewn IPAA are not “immune” to dysplasia or cuffitis, because islands of the rectal mucosa can regrow or may be inadvertently preserved due to incomplete mucosectomy; indeed, in one series, residual rectal mucosa was identified in 20% of patients who underwent hand-sewn IPAA with mucosectomy[167].

Pouch dysplasia is distinct from cuff dysplasia, and relates to pathological changes observed in the true reservoir mucosa. Such pathological changes described include chronic inflammation, crypt hyperplasia, and increased goblet cells. These features are akin to colonic metaplasia, and there is suggestion that colonic-like mucosa in the neorectum could be a potentially premalignant condition[85]. Indeed, neoplastic characteristics such as aneuploidy and different degrees of dysplasia have been reported in such “metaplastic” tissue[168], and pouch adenoma (Figure 7), and even adenocarcinoma (Figure 8), are well-documented entities, though overall rare.[169,170].

Figure 7
Figure 7 Pouch adenoma. A: Magnetic resonance image and endoscopic view of a pedunculated pouch polyp (arrow) arising in the mid pouch that was completely excised endoscopically; B: A serrated, near circumferential, lesion (arrow) that required formal pouch excision. Both pouch lesions were confirmed histologically to be pouch adenomas.
Figure 8
Figure 8 A magnetic resonance image of a pouch with a large exophytic lesion (arrow) arising from its posterior aspect. Biopsies and formal histopathology confirmed this to be a pouch carcinoma.

The potential risk of cuff or pouch dysplasia explains the rationale for careful follow-up and pouch surveillance of all patients after IPAA, which includes regular clinical and endoscopic examination of the ileal pouch and cuff. However, there is limited evidence for the ideal frequency of endoscopic surveillance. The British Society of Gastroenterology surveillance guidelines distinguish low risk (no high risk factors) and high risk (PSC, previous colorectal neoplasia, atrophic mucosa) groups following colectomy, and recommend surveillance intervals of 5 years and 1 year, respectively[171], but there is wide variation to this in daily practice[165].

IPAA and fecundity: Issues related to fertility, pregnancy, and the preferred method of delivery are of great importance to the female IPAA patient, particularly given that many are young and within their reproductive years. IPAA is associated with decreased female fertility[172-176], with approximately 40% having difficulty in conception following pouch surgery[174]. One study from Scandinavia compared the fecundity of women with FAP following colectomy/IRA versus IPAA; in that study, the fecundity of women following IRA was similar to that of the general population, but fecundity dropped to 54% following RPC/IPAA[177]. Preoperatively, young women should be counselled about the impact of pouch surgery on fecundity, and may decide to defer proctectomy until they have completed their family.

The significant decrease in postoperative fertility has been attributed to probable tubal occlusion from adhesions. One approach to circumvent this is the placement of an anti-adhesive membrane around the fallopian tubes and ovaries during surgery. Additionally, as laparoscopic surgery is associated with fewer adhesions, this approach may result in better preservation of female fertility[178,179]. Autonomic neuropraxia or inadvertent transection of the hypogastric nerves have also been suggested to lead to decreased lubrication and dyspareunia[180], contributing to decreased fertility postoperatively. Interestingly, a recent study has demonstrated that IPAA has minimal impact on male fertility[181].

The optimal method of delivery remains debated. Caesarean delivery decreases the risk of incontinence secondary to obstetric anal sphincter injury, but yet is associated with potential complications from abdominal surgery, including pouch injury. Vaginal delivery may cause pudendal nerve damage and injury to the anal sphincter mechanism, but minimises the risks associated with abdominal surgery. Indeed, studies have shown vaginal delivery to be safe after IPAA[182]. The decision regarding mode of delivery is made on an individualised basis after discussion with the patient. Many patients (and clinicians) will opt for an elective Caesarean section rather than risk compromise of pouch function.


RPC/IPAA has undergone significant modification since its introduction in 1978, and future directions of research in pouch surgery must include the robust assessment of novel techniques, including robotic surgery, SILS, and TaTME. The two primary indications for IPAA are UC and FAP, with the majority of pouches being fashioned for UC. In any case, the aim of IPAA surgery is the same: 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 with an ileal pouch, but this procedure is associated with significant morbidity. Complications following IPAA surgery can be grouped into those which are “early” and “late”. Pelvic sepsis is a common early complication with far-reaching consequences in terms of long-term pouch dysfunction, but a high index of suspicion and prompt radiological or surgical intervention significantly reduces the chance of ultimate pouch failure. Even in the absence of sepsis, pouch dysfunction is a long-term complication that may have a myriad of underlying causes. Pouchitis is one common cause that remains incompletely understood and at times, difficult to manage. Other causes of dysfunction include impaired pouch mano-volumetry, pouch/anastomotic stricture, and cuffitis. 10% of patients succumb to the diagnosis of pouch failure, which is traditionally associated with the need for pouch excision. Finally, as the follow-up period following pouch surgery lengthens, the incidence of unique complications such as pouch dysplasia and malignancy can be expected to increase. The best management and surveillance strategies for such clinical entities remains unclear, but emerging evidence from this burgeoning field of research should help guide future clinical practice.


Manuscript source: Unsolicited manuscript

Specialty type: Gastroenterology and hepatology

Country of origin: United Kingdom

Peer-review report classification

Grade A (Excellent): A

Grade B (Very good): B

Grade C (Good): 0

Grade D (Fair): 0

Grade E (Poor): D

P-Reviewer: Cheng DY, Madnani MA, Sandberg KC S-Editor: Yan JP L-Editor: A E-Editor: Ma YJ

1.  Nissen RR. Demonstrationen aus der operativen Chirurgie, no 39. Berlin Surgical Society. Zentralbl Chir. 1933;15:888.  [PubMed]  [DOI]  [Cited in This Article: ]
2.  BEST RR. Anastomosis of the ileum to the lower part of the rectum and anus; a report on experiences with ileorectostomy and ileoproctostomy, with special reference to polyposis. Arch Surg. 1948;57:276-285.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 16]  [Cited by in F6Publishing: 17]  [Article Influence: 1.1]  [Reference Citation Analysis (0)]
3.  Ravitch MM, Sabiston DC. Anal ileostomy with preservation of the sphincter; a proposed operation in patients requiring total colectomy for benign lesions. Surg Gynecol Obstet. 1947;84:1095-1099.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 4]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
4.  Valiente MA, Bacon HE. Construction of pouch using pantaloon technic for pull-through of ileum following total colectomy; report of experimental work and results. Am J Surg. 1955;90:742-750.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 73]  [Cited by in F6Publishing: 79]  [Article Influence: 1.2]  [Reference Citation Analysis (0)]
5.  Kock NG. Intra-abdominal "reservoir" in patients with permanent ileostomy. Preliminary observations on a procedure resulting in fecal "continence" in five ileostomy patients. Arch Surg. 1969;99:223-231.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 445]  [Cited by in F6Publishing: 434]  [Article Influence: 8.0]  [Reference Citation Analysis (0)]
6.  Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. Br Med J. 1978;2:85-88.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 968]  [Cited by in F6Publishing: 889]  [Article Influence: 19.8]  [Reference Citation Analysis (0)]
7.  Utsunomiya J, Iwama T, Imajo M, Matsuo S, Sawai S, Yaegashi K, Hirayama R. Total colectomy, mucosal proctectomy, and ileoanal anastomosis. Dis Colon Rectum. 1980;23:459-466.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 525]  [Cited by in F6Publishing: 519]  [Article Influence: 12.1]  [Reference Citation Analysis (0)]
8.  Lovegrove RE, Heriot AG, Constantinides V, Tilney HS, Darzi AW, Fazio VW, Nicholls RJ, Tekkis PP. Meta-analysis of short-term and long-term outcomes of J, W and S ileal reservoirs for restorative proctocolectomy. Colorectal Dis. 2007;9:310-320.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 108]  [Cited by in F6Publishing: 101]  [Article Influence: 6.3]  [Reference Citation Analysis (0)]
9.  Nicholls RJ, Pezim ME. Restorative proctocolectomy with ileal reservoir for ulcerative colitis and familial adenomatous polyposis: A comparison of three reservoir designs. Br J Surg. 1985;72:470-474.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 242]  [Cited by in F6Publishing: 216]  [Article Influence: 5.7]  [Reference Citation Analysis (0)]
10.  Miller R, Lewis GT, Bartolo DC, Cervero F, Mortensen NJ. Sensory discrimination and dynamic activity in the anorectum: Evidence using a new ambulatory technique. Br J Surg. 1988;75:1003-1007.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 83]  [Cited by in F6Publishing: 65]  [Article Influence: 1.9]  [Reference Citation Analysis (0)]
11.  Tuckson W, Lavery I, Fazio V, Oakley J, Church J, Milsom J. Manometric and functional comparison of ileal pouch anal anastomosis with and without anal manipulation. Am J Surg. 1991;161:90-5; discussion 95-6.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 122]  [Cited by in F6Publishing: 103]  [Article Influence: 3.2]  [Reference Citation Analysis (0)]
12.  Lovegrove RE, Constantinides VA, Heriot AG, Athanasiou T, Darzi A, Remzi FH, Nicholls RJ, Fazio VW, Tekkis PP. A comparison of hand-sewn versus stapled ileal pouch anal anastomosis (IPAA) following proctocolectomy: A meta-analysis of 4183 patients. Ann Surg. 2006;244:18-26.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 269]  [Cited by in F6Publishing: 279]  [Article Influence: 16.4]  [Reference Citation Analysis (0)]
13.  Singh P, Bhangu A, Nicholls RJ, Tekkis P. A systematic review and meta-analysis of laparoscopic vs open restorative proctocolectomy. Colorectal Dis. 2013;15:e340-e351.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 47]  [Cited by in F6Publishing: 48]  [Article Influence: 4.8]  [Reference Citation Analysis (0)]
14.  Mark-Christensen A, Pachler FR, Nørager CB, Jepsen P, Laurberg S, Tøttrup A. Short-term Outcome of Robot-assisted and Open IPAA: An Observational Single-center Study. Dis Colon Rectum. 2016;59:201-207.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 32]  [Cited by in F6Publishing: 32]  [Article Influence: 4.6]  [Reference Citation Analysis (0)]
15.  Lightner AL, Kelley SR, Larson DW. Robotic Platform for an IPAA. Dis Colon Rectum. 2018;61:869-874.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 23]  [Cited by in F6Publishing: 21]  [Article Influence: 4.2]  [Reference Citation Analysis (0)]
16.  Gash KJ, Goede AC, Kaldowski B, Vestweber B, Dixon AR. Single incision laparoscopic (SILS) restorative proctocolectomy with ileal pouch-anal anastomosis. Surg Endosc. 2011;25:3877-3880.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 41]  [Cited by in F6Publishing: 43]  [Article Influence: 3.6]  [Reference Citation Analysis (0)]
17.  Leo CA, Samaranayake S, Perry-Woodford ZL, Vitone L, Faiz O, Hodgkinson JD, Shaikh I, Warusavitarne J. Initial experience of restorative proctocolectomy for ulcerative colitis by transanal total mesorectal rectal excision and single-incision abdominal laparoscopic surgery. Colorectal Dis. 2016;18:1162-1166.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 53]  [Cited by in F6Publishing: 54]  [Article Influence: 7.7]  [Reference Citation Analysis (0)]
18.  Tasende MM, Delgado S, Jimenez M, Del Gobbo GD, Fernández-Hevia M, DeLacy B, Balust J, Lacy AM. Minimal invasive surgery: NOSE and NOTES in ulcerative colitis. Surg Endosc. 2015;29:3313-3318.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 22]  [Cited by in F6Publishing: 17]  [Article Influence: 2.1]  [Reference Citation Analysis (0)]
19.  Homma S, Kawamata F, Shibasaki S, Kawamura H, Takahashi N, Taketomi A. Does reduced-port laparoscopic surgery for medically uncontrolled ulcerative colitis do more harm than good? Asian J Endosc Surg. 2016;9:24-31.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 10]  [Cited by in F6Publishing: 10]  [Article Influence: 1.4]  [Reference Citation Analysis (0)]
20.  de Lacy FB, Keller DS, Martin-Perez B, Emile SH, Chand M, Spinelli A, Lacy AM. The current state of the transanal approach to the ileal pouch-anal anastomosis. Surg Endosc. 2019;.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 13]  [Article Influence: 3.3]  [Reference Citation Analysis (0)]
21.  Fearnhead NS, Lee MJ, Acheson AG, Worley G, Faiz OD, Brown SR. Variation in practice of pouch surgery in England - using SWORD data to cut to the chase and justify centralization. Colorectal Dis. 2018;20:597-605.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 9]  [Cited by in F6Publishing: 7]  [Article Influence: 1.4]  [Reference Citation Analysis (0)]
22.  Parc Y, Reboul-Marty J, Lefevre JH, Shields C, Chafai N, Tiret E. Restorative Proctocolectomy and Ileal Pouch-anal Anastomosis. Ann Surg. 2015;262:849-53; discussion 853-4.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 21]  [Cited by in F6Publishing: 22]  [Article Influence: 3.1]  [Reference Citation Analysis (0)]
23.  Hueting WE, Buskens E, van der Tweel I, Gooszen HG, van Laarhoven CJ. Results and complications after ileal pouch anal anastomosis: A meta-analysis of 43 observational studies comprising 9,317 patients. Dig Surg. 2005;22:69-79.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 225]  [Cited by in F6Publishing: 177]  [Article Influence: 9.8]  [Reference Citation Analysis (0)]
24.  Trigui A, Frikha F, Rejab H, Ben Ameur H, Triki H, Ben Amar M, Mzali R. Ileal pouch-anal anastomosis: Points of controversy. J Visc Surg. 2014;151:281-288.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 9]  [Article Influence: 1.0]  [Reference Citation Analysis (0)]
25.  Langholz E, Munkholm P, Davidsen M, Binder V. Colorectal cancer risk and mortality in patients with ulcerative colitis. Gastroenterology. 1992;103:1444-1451.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 368]  [Cited by in F6Publishing: 364]  [Article Influence: 11.7]  [Reference Citation Analysis (0)]
26.  Hendriksen C, Kreiner S, Binder V. Long term prognosis in ulcerative colitis--based on results from a regional patient group from the county of Copenhagen. Gut. 1985;26:158-163.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 210]  [Cited by in F6Publishing: 224]  [Article Influence: 5.9]  [Reference Citation Analysis (0)]
27.  Kaplan GG, Seow CH, Ghosh S, Molodecky N, Rezaie A, Moran GW, Proulx MC, Hubbard J, MacLean A, Buie D, Panaccione R. Decreasing colectomy rates for ulcerative colitis: A population-based time trend study. Am J Gastroenterol. 2012;107:1879-1887.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 151]  [Cited by in F6Publishing: 134]  [Article Influence: 12.2]  [Reference Citation Analysis (0)]
28.  Rönnblom A, Holmström T, Tanghöj H, Karlbom U, Thörn M, Sjöberg D. Low colectomy rate five years after diagnosis of ulcerative colitis. Results from a prospective population-based cohort in Sweden (ICURE) diagnosed during 2005-2009. Scand J Gastroenterol. 2016;51:1339-1344.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 20]  [Cited by in F6Publishing: 20]  [Article Influence: 2.9]  [Reference Citation Analysis (0)]
29.  Parragi L, Fournier N, Zeitz J, Scharl M, Greuter T, Schreiner P, Misselwitz B, Safroneeva E, Schoepfer AM, Vavricka SR, Rogler G, Biedermann L; Swiss IBD Cohort Study Group. Colectomy Rates in Ulcerative Colitis are Low and Decreasing: 10-year Follow-up Data From the Swiss IBD Cohort Study. J Crohns Colitis. 2018;12:811-818.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 67]  [Cited by in F6Publishing: 64]  [Article Influence: 12.8]  [Reference Citation Analysis (0)]
30.  BROOKE BN. The management of an ileostomy, including its complications. Lancet. 1952;2:102-104.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 248]  [Cited by in F6Publishing: 260]  [Article Influence: 3.7]  [Reference Citation Analysis (0)]
31.  BROOKE BN. Outcome of surgery for ulcerative colitis. Lancet. 1956;271:532-536.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 52]  [Cited by in F6Publishing: 54]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
32.  Watts JM, de Dombal FT, Goligher JC. Long-term complications and prognosis following major surgery for ulcerative colitis. Br J Surg. 1966;53:1014-1023.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 152]  [Cited by in F6Publishing: 146]  [Article Influence: 2.6]  [Reference Citation Analysis (0)]
33.  Druss RG, O'Connor JF, Prudden JF, Stern LO. Psychologic response to colectomy. Arch Gen Psychiatry. 1968;18:53-59.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 53]  [Cited by in F6Publishing: 52]  [Article Influence: 0.9]  [Reference Citation Analysis (0)]
34.  Failes D. The Kock continent ileostomy: A preliminary report. Aust N Z J Surg. 1976;46:125-130.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 12]  [Cited by in F6Publishing: 13]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
35.  Williams NS. Restorative proctocolectomy is the first choice elective surgical treatment for ulcerative colitis. Br J Surg. 1989;76:1109-1110.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 68]  [Cited by in F6Publishing: 61]  [Article Influence: 1.8]  [Reference Citation Analysis (0)]
36.  Brown SR, Fearnhead NS, Faiz OD, Abercrombie JF, Acheson AG, Arnott RG, Clark SK, Clifford S, Davies RJ, Davies MM, Douie WJP, Dunlop MG, Epstein JC, Evans MD, George BD, Guy RJ, Hargest R, Hawthorne AB, Hill J, Hughes GW, Limdi JK, Maxwell-Armstrong CA, O'Connell PR, Pinkney TD, Pipe J, Sagar PM, Singh B, Soop M, Terry H, Torkington J, Verjee A, Walsh CJ, Warusavitarne JH, Williams AB, Williams GL, Wilson RG; ACPGBI IBD Surgery Consensus Collaboration. The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease. Colorectal Dis. 2018;20 Suppl 8:3-117.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 41]  [Cited by in F6Publishing: 36]  [Article Influence: 7.2]  [Reference Citation Analysis (0)]
37.  Heuschen UA, Hinz U, Allemeyer EH, Autschbach F, Stern J, Lucas M, Herfarth C, Heuschen G. Risk factors for ileoanal J pouch-related septic complications in ulcerative colitis and familial adenomatous polyposis. Ann Surg. 2002;235:207-216.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 175]  [Cited by in F6Publishing: 187]  [Article Influence: 8.9]  [Reference Citation Analysis (0)]
38.  Lim M, Sagar P, Abdulgader A, Thekkinkattil D, Burke D. The impact of preoperative immunomodulation on pouch-related septic complications after ileal pouch-anal anastomosis. Dis Colon Rectum. 2007;50:943-951.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 52]  [Cited by in F6Publishing: 48]  [Article Influence: 3.0]  [Reference Citation Analysis (0)]
39.  Øresland T, Bemelman WA, Sampietro GM, Spinelli A, Windsor A, Ferrante M, Marteau P, Zmora O, Kotze PG, Espin-Basany E, Tiret E, Sica G, Panis Y, Faerden AE, Biancone L, Angriman I, Serclova Z, de Buck van Overstraeten A, Gionchetti P, Stassen L, Warusavitarne J, Adamina M, Dignass A, Eliakim R, Magro F, D'Hoore A; European Crohn's and Colitis Organisation (ECCO). European evidence based consensus on surgery for ulcerative colitis. J Crohns Colitis. 2015;9:4-25.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 240]  [Cited by in F6Publishing: 235]  [Article Influence: 29.4]  [Reference Citation Analysis (0)]
40.  Yang Z, Wu Q, Wu K, Fan D. Meta-analysis: Pre-operative infliximab treatment and short-term post-operative complications in patients with ulcerative colitis. Aliment Pharmacol Ther. 2010;31:486-492.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 109]  [Cited by in F6Publishing: 75]  [Article Influence: 5.8]  [Reference Citation Analysis (0)]
41.  Zittan E, Milgrom R, Ma GW, Wong-Chong N, OʼConnor B, McLeod RS, MacRae HM, Greenberg GR, Nguyen GC, Croitoru K, Steinhart AH, Cohen Z, Silverberg MS. Preoperative Anti-tumor Necrosis Factor Therapy in Patients with Ulcerative Colitis Is Not Associated with an Increased Risk of Infectious and Noninfectious Complications After Ileal Pouch-anal Anastomosis. Inflamm Bowel Dis. 2016;22:2442-2447.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 34]  [Cited by in F6Publishing: 25]  [Article Influence: 3.6]  [Reference Citation Analysis (0)]
42.  Gainsbury ML, Chu DI, Howard LA, Coukos JA, Farraye FA, Stucchi AF, Becker JM. Preoperative infliximab is not associated with an increased risk of short-term postoperative complications after restorative proctocolectomy and ileal pouch-anal anastomosis. J Gastrointest Surg. 2011;15:397-403.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 80]  [Cited by in F6Publishing: 80]  [Article Influence: 6.7]  [Reference Citation Analysis (0)]
43.  Shah ED, Farida JP, Siegel CA, Chong K, Melmed GY. Risk for Overall Infection with Anti-TNF and Anti-integrin Agents Used in IBD: A Systematic Review and Meta-analysis. Inflamm Bowel Dis. 2017;23:570-577.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 68]  [Cited by in F6Publishing: 58]  [Article Influence: 9.7]  [Reference Citation Analysis (0)]
44.  Ferrante M, de Buck van Overstraeten A, Schils N, Moens A, Van Assche G, Wolthuis A, Vermeire S, D'Hoore A. Perioperative Use of Vedolizumab is not Associated with Postoperative Infectious Complications in Patients with Ulcerative Colitis Undergoing Colectomy. J Crohns Colitis. 2017;11:1353-1361.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 50]  [Cited by in F6Publishing: 51]  [Article Influence: 8.5]  [Reference Citation Analysis (0)]
45.  Lightner AL, McKenna NP, Moncrief S, Pemberton JH, Raffals LE, Mathis KL. Surgical Outcomes in Vedolizumab-Treated Patients with Ulcerative Colitis. Inflamm Bowel Dis. 2017;23:2197-2201.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 45]  [Cited by in F6Publishing: 41]  [Article Influence: 6.8]  [Reference Citation Analysis (0)]
46.  de Montbrun SL, Johnson PM. Proximal diversion at the time of ileal pouch-anal anastomosis for ulcerative colitis: Current practices of North American colorectal surgeons. Dis Colon Rectum. 2009;52:1178-1183.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 23]  [Cited by in F6Publishing: 24]  [Article Influence: 1.7]  [Reference Citation Analysis (0)]
47.  Gunnarsson U, Karlbom U, Docker M, Raab Y, Påhlman L. Proctocolectomy and pelvic pouch--is a diverting stoma dangerous for the patient? Colorectal Dis. 2004;6:23-27.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 33]  [Cited by in F6Publishing: 31]  [Article Influence: 1.6]  [Reference Citation Analysis (0)]
48.  Edwards DP, Chisholm EM, Donaldson DR. Closure of transverse loop colostomy and loop ileostomy. Ann R Coll Surg Engl. 1998;80:33-35.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 9]  [Cited by in F6Publishing: 9]  [Article Influence: 0.4]  [Reference Citation Analysis (0)]
49.  van de Pavoordt HD, Fazio VW, Jagelman DG, Lavery IC, Weakley FL. The outcome of loop ileostomy closure in 293 cases. Int J Colorectal Dis. 1987;2:214-217.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 60]  [Cited by in F6Publishing: 55]  [Article Influence: 1.5]  [Reference Citation Analysis (0)]
50.  Wexner SD, Taranow DA, Johansen OB, Itzkowitz F, Daniel N, Nogueras JJ, Jagelman DG. Loop ileostomy is a safe option for fecal diversion. Dis Colon Rectum. 1993;36:349-354.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 97]  [Cited by in F6Publishing: 97]  [Article Influence: 3.2]  [Reference Citation Analysis (0)]
51.  Winslet MC, Barsoum G, Pringle W, Fox K, Keighley MR. Loop ileostomy after ileal pouch-anal anastomosis--is it necessary? Dis Colon Rectum. 1991;34:267-270.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 40]  [Cited by in F6Publishing: 42]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]
52.  Hosie KB, Grobler SP, Keighley MR. Temporary loop ileostomy following restorative proctocolectomy. Br J Surg. 1992;79:33-34.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 28]  [Cited by in F6Publishing: 30]  [Article Influence: 1.0]  [Reference Citation Analysis (0)]
53.  Senapati A, Nicholls RJ, Ritchie JK, Tibbs CJ, Hawley PR. Temporary loop ileostomy for restorative proctocolectomy. Br J Surg. 1993;80:628-630.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 53]  [Cited by in F6Publishing: 49]  [Article Influence: 1.6]  [Reference Citation Analysis (0)]
54.  Lewis P, Bartolo DC. Closure of loop ileostomy after restorative proctocolectomy. Ann R Coll Surg Engl. 1990;72:263-265.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 1]  [Article Influence: 0.0]  [Reference Citation Analysis (0)]
55.  Mann LJ, Stewart PJ, Goodwin RJ, Chapuis PH, Bokey EL. Complications following closure of loop ileostomy. Aust N Z J Surg. 1991;61:493-496.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 22]  [Cited by in F6Publishing: 28]  [Article Influence: 0.9]  [Reference Citation Analysis (0)]
56.  Phang PT, Hain JM, Perez-Ramirez JJ, Madoff RD, Gemlo BT. Techniques and complications of ileostomy takedown. Am J Surg. 1999;177:463-466.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 96]  [Cited by in F6Publishing: 102]  [Article Influence: 4.3]  [Reference Citation Analysis (0)]
57.  Grobler SP, Hosie KB, Keighley MR. Randomized trial of loop ileostomy in restorative proctocolectomy. Br J Surg. 1992;79:903-906.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 106]  [Cited by in F6Publishing: 94]  [Article Influence: 3.0]  [Reference Citation Analysis (0)]
58.  Weston-Petrides GK, Lovegrove RE, Tilney HS, Heriot AG, Nicholls RJ, Mortensen NJ, Fazio VW, Tekkis PP. Comparison of outcomes after restorative proctocolectomy with or without defunctioning ileostomy. Arch Surg. 2008;143:406-412.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 135]  [Cited by in F6Publishing: 140]  [Article Influence: 9.3]  [Reference Citation Analysis (0)]
59.  Tudyka VN, Clark SK. Surgical treatment in familial adenomatous polyposis. Ann Gastroenterol. 2012;25:201-206.  [PubMed]  [DOI]  [Cited in This Article: ]
60.  Campos FG. Surgical treatment of familial adenomatous polyposis: Dilemmas and current recommendations. World J Gastroenterol. 2014;20:16620-16629.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in CrossRef: 54]  [Cited by in F6Publishing: 47]  [Article Influence: 5.2]  [Reference Citation Analysis (0)]
61.  Möslein G. Surgical considerations in FAP-related pouch surgery: Could we do better? Fam Cancer. 2016;15:457-466.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 22]  [Cited by in F6Publishing: 17]  [Article Influence: 2.8]  [Reference Citation Analysis (0)]
62.  Ellis CN. Colonic adenomatous polyposis syndromes: Clinical management. Clin Colon Rectal Surg. 2008;21:256-262.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 16]  [Cited by in F6Publishing: 10]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
63.  Chittleborough TJ, Warrier SK, Heriot AG, Kalady M, Church J. Dispelling misconceptions in the management of familial adenomatous polyposis. ANZ J Surg. 2017;87:441-445.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 12]  [Cited by in F6Publishing: 13]  [Article Influence: 2.2]  [Reference Citation Analysis (0)]
64.  Church J, Burke C, McGannon E, Pastean O, Clark B. Predicting polyposis severity by proctoscopy: How reliable is it? Dis Colon Rectum. 2001;44:1249-1254.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 73]  [Cited by in F6Publishing: 75]  [Article Influence: 3.4]  [Reference Citation Analysis (0)]
65.  Wu JS, Paul P, McGannon EA, Church JM. APC genotype, polyp number, and surgical options in familial adenomatous polyposis. Ann Surg. 1998;227:57-62.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 115]  [Cited by in F6Publishing: 122]  [Article Influence: 4.9]  [Reference Citation Analysis (0)]
66.  Chang S, Shen B, Remzi F. When Not to Pouch: Important Considerations for Patient Selection for Ileal Pouch-Anal Anastomosis. Gastroenterol Hepatol (N Y). 2017;13:466-475.  [PubMed]  [DOI]  [Cited in This Article: ]
67.  McLaughlin SD, Clark SK, Tekkis PP, Ciclitira PJ, Nicholls RJ. Review article: Restorative proctocolectomy, indications, management of complications and follow-up--a guide for gastroenterologists. Aliment Pharmacol Ther. 2008;27:895-909.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 78]  [Cited by in F6Publishing: 54]  [Article Influence: 3.6]  [Reference Citation Analysis (0)]
68.  Yu CS, Pemberton JH, Larson D. Ileal pouch-anal anastomosis in patients with indeterminate colitis: Long-term results. Dis Colon Rectum. 2000;43:1487-1496.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 177]  [Cited by in F6Publishing: 176]  [Article Influence: 7.7]  [Reference Citation Analysis (0)]
69.  Reese GE, Lovegrove RE, Tilney HS, Yamamoto T, Heriot AG, Fazio VW, Tekkis PP. The effect of Crohn's disease on outcomes after restorative proctocolectomy. Dis Colon Rectum. 2007;50:239-250.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 64]  [Cited by in F6Publishing: 62]  [Article Influence: 3.9]  [Reference Citation Analysis (0)]
70.  Tekkis PP, Heriot AG, Smith O, Smith JJ, Windsor AC, Nicholls RJ. Long-term outcomes of restorative proctocolectomy for Crohn's disease and indeterminate colitis. Colorectal Dis. 2005;7:218-223.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 77]  [Cited by in F6Publishing: 81]  [Article Influence: 4.5]  [Reference Citation Analysis (0)]
71.  Sagar PM, Dozois RR, Wolff BG. Long-term results of ileal pouch-anal anastomosis in patients with Crohn's disease. Dis Colon Rectum. 1996;39:893-898.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 180]  [Cited by in F6Publishing: 169]  [Article Influence: 6.3]  [Reference Citation Analysis (0)]
72.  Regimbeau JM, Panis Y, Pocard M, Bouhnik Y, Lavergne-Slove A, Rufat P, Matuchansky C, Valleur P. Long-term results of ileal pouch-anal anastomosis for colorectal Crohn's disease. Dis Colon Rectum. 2001;44:769-778.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 130]  [Cited by in F6Publishing: 140]  [Article Influence: 6.4]  [Reference Citation Analysis (0)]
73.  Bemelman WA, Warusavitarne J, Sampietro GM, Serclova Z, Zmora O, Luglio G, de Buck van Overstraeten A, Burke JP, Buskens CJ, Colombo F, Dias JA, Eliakim R, Elosua T, Gecim IE, Kolacek S, Kierkus J, Kolho KL, Lefevre JH, Millan M, Panis Y, Pinkney T, Russell RK, Shwaartz C, Vaizey C, Yassin N, D'Hoore A. ECCO-ESCP Consensus on Surgery for Crohn's Disease. J Crohns Colitis. 2018;12:1-16.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 60]  [Cited by in F6Publishing: 84]  [Article Influence: 16.8]  [Reference Citation Analysis (0)]
74.  Joyce MR, Fazio VW. Can ileal pouch anal anastomosis be used in Crohn's disease? Adv Surg. 2009;43:111-137.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 18]  [Cited by in F6Publishing: 16]  [Article Influence: 1.1]  [Reference Citation Analysis (0)]
75.  Penna C, Dozois R, Tremaine W, Sandborn W, LaRusso N, Schleck C, Ilstrup D. Pouchitis after ileal pouch-anal anastomosis for ulcerative colitis occurs with increased frequency in patients with associated primary sclerosing cholangitis. Gut. 1996;38:234-239.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 404]  [Cited by in F6Publishing: 435]  [Article Influence: 16.1]  [Reference Citation Analysis (0)]
76.  Pavlides M, Cleland J, Rahman M, Christian A, Doyle J, Gaunt R, Travis S, Mortensen N, Chapman R. Outcomes after ileal pouch anal anastomosis in patients with primary sclerosing cholangitis. J Crohns Colitis. 2014;8:662-670.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 38]  [Cited by in F6Publishing: 36]  [Article Influence: 4.0]  [Reference Citation Analysis (0)]
77.  Rahman M, Desmond P, Mortensen N, Chapman RW. The clinical impact of primary sclerosing cholangitis in patients with an ileal pouch-anal anastomosis for ulcerative colitis. Int J Colorectal Dis. 2011;26:553-559.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 30]  [Cited by in F6Publishing: 28]  [Article Influence: 2.3]  [Reference Citation Analysis (0)]
78.  Dafnis G. Early and late surgical outcomes of ileal pouch-anal anastomosis within a defined population in Sweden. Eur J Gastroenterol Hepatol. 2016;28:842-849.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 15]  [Cited by in F6Publishing: 14]  [Article Influence: 2.0]  [Reference Citation Analysis (0)]
79.  Yang P, Oresland T, Järnerot G, Hultén L, Danielsson D. Perinuclear antineutrophil cytoplasmic antibody in pouchitis after proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis. Scand J Gastroenterol. 1996;31:594-598.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 36]  [Cited by in F6Publishing: 32]  [Article Influence: 1.2]  [Reference Citation Analysis (0)]
80.  Fleshner PR, Vasiliauskas EA, Kam LY, Fleshner NE, Gaiennie J, Abreu-Martin MT, Targan SR. High level perinuclear antineutrophil cytoplasmic antibody (pANCA) in ulcerative colitis patients before colectomy predicts the development of chronic pouchitis after ileal pouch-anal anastomosis. Gut. 2001;49:671-677.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 184]  [Cited by in F6Publishing: 196]  [Article Influence: 8.9]  [Reference Citation Analysis (0)]
81.  Köhler LW, Pemberton JH, Zinsmeister AR, Kelly KA. Quality of life after proctocolectomy. A comparison of Brooke ileostomy, Kock pouch, and ileal pouch-anal anastomosis. Gastroenterology. 1991;101:679-684.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2]  [Cited by in F6Publishing: 2]  [Article Influence: 0.1]  [Reference Citation Analysis (0)]
82.  Pemberton JH, Phillips SF, Ready RR, Zinsmeister AR, Beahrs OH. Quality of life after Brooke ileostomy and ileal pouch-anal anastomosis. Comparison of performance status. Ann Surg. 1989;209:620-6; discussion 626-8.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 157]  [Cited by in F6Publishing: 132]  [Article Influence: 3.9]  [Reference Citation Analysis (0)]
83.  Heuschen UA, Heuschen G, Lucas M, Hinz U, Stern J, Herfarth C. [Pre- and postoperative quality of life of patients with ulcerative colitis and familial adenomatous polyposis with ileoanal pouch operation]. Chirurg. 1998;69:1329-1333.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 15]  [Cited by in F6Publishing: 15]  [Article Influence: 0.6]  [Reference Citation Analysis (0)]
84.  Tulchinsky H, Hawley PR, Nicholls J. Long-term failure after restorative proctocolectomy for ulcerative colitis. Ann Surg. 2003;238:229-234.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 162]  [Cited by in F6Publishing: 190]  [Article Influence: 9.5]  [Reference Citation Analysis (0)]
85.  Gorgun E, Remzi FH. Complications of ileoanal pouches. Clin Colon Rectal Surg. 2004;17:43-55.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 57]  [Cited by in F6Publishing: 50]  [Article Influence: 3.8]  [Reference Citation Analysis (1)]
86.  Fazio VW, Ziv Y, Church JM, Oakley JR, Lavery IC, Milsom JW, Schroeder TK. Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg. 1995;222:120-127.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 947]  [Cited by in F6Publishing: 875]  [Article Influence: 31.3]  [Reference Citation Analysis (0)]
87.  Sagar PM, Pemberton JH. Intraoperative, postoperative and reoperative problems with ileoanal pouches. Br J Surg. 2012;99:454-468.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 83]  [Cited by in F6Publishing: 83]  [Article Influence: 7.5]  [Reference Citation Analysis (0)]
88.  Lian L, Serclova Z, Fazio VW, Kiran RP, Remzi F, Shen B. Clinical features and management of postoperative pouch bleeding after ileal pouch-anal anastomosis (IPAA). J Gastrointest Surg. 2008;12:1991-1994.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 22]  [Cited by in F6Publishing: 24]  [Article Influence: 1.6]  [Reference Citation Analysis (0)]
89.  Crema MD, Richarme D, Azizi L, Hoeffel CC, Tubiana JM, Arrivé L. Pouchography, CT, and MRI features of ileal J pouch-anal anastomosis. AJR Am J Roentgenol. 2006;187:W594-W603.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 36]  [Cited by in F6Publishing: 37]  [Article Influence: 2.2]  [Reference Citation Analysis (0)]
90.  Heuschen UA, Allemeyer EH, Hinz U, Lucas M, Herfarth C, Heuschen G. Outcome after septic complications in J pouch procedures. Br J Surg. 2002;89:194-200.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 21]  [Article Influence: 1.0]  [Reference Citation Analysis (0)]
91.  Worley GHT, Segal JP, Warusavitarne J, Clark SK, Faiz OD. Management of early pouch-related septic complications in ulcerative colitis: A systematic review. Colorectal Dis. 2018;20:O181-O189.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 9]  [Cited by in F6Publishing: 8]  [Article Influence: 1.6]  [Reference Citation Analysis (0)]
92.  van Koperen PJ, van Berge Henegouwen MI, Rosman C, Bakker CM, Heres P, Slors JF, Bemelman WA. The Dutch multicenter experience of the endo-sponge treatment for anastomotic leakage after colorectal surgery. Surg Endosc. 2009;23:1379-1383.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 110]  [Cited by in F6Publishing: 116]  [Article Influence: 7.7]  [Reference Citation Analysis (0)]
93.  Remzi FH, Fazio VW, Oncel M, Baker ME, Church JM, Ooi BS, Connor JT, Preen M, Einstein D. Portal vein thrombi after restorative proctocolectomy. Surgery. 2002;132:655-61; discussion 661-2.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 75]  [Cited by in F6Publishing: 78]  [Article Influence: 3.7]  [Reference Citation Analysis (0)]
94.  Baker ME, Remzi F, Einstein D, Oncel M, Herts B, Remer E, Fazio V. CT depiction of portal vein thrombi after creation of ileal pouch-anal anastomosis. Radiology. 2003;227:73-79.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 36]  [Cited by in F6Publishing: 35]  [Article Influence: 1.8]  [Reference Citation Analysis (0)]
95.  Uyeda JW, LeBedis CA, Penn DR, Murakami AM, Ramalingam V, Anderson SW, Soto JA, Gupta A. Ileal pouch-anal anastomosis surgery: Anatomy, postoperative complications, and image-guided intervention. Semin Ultrasound CT MR. 2013;34:299-310.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 3]  [Cited by in F6Publishing: 3]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
96.  Millan M, Hull TL, Hammel J, Remzi F. Portal vein thrombi after restorative proctocolectomy: Serious complication without long-term sequelae. Dis Colon Rectum. 2007;50:1540-1544.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 30]  [Cited by in F6Publishing: 28]  [Article Influence: 1.8]  [Reference Citation Analysis (0)]
97.  Shen B, Remzi FH, Lavery IC, Lashner BA, Fazio VW. A proposed classification of ileal pouch disorders and associated complications after restorative proctocolectomy. Clin Gastroenterol Hepatol. 2008;6:145-58; quiz 124.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 173]  [Cited by in F6Publishing: 204]  [Article Influence: 13.6]  [Reference Citation Analysis (0)]
98.  Groom JS, Nicholls RJ, Hawley PR, Phillips RK. Pouch-vaginal fistula. Br J Surg. 1993;80:936-940.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 84]  [Cited by in F6Publishing: 82]  [Article Influence: 2.7]  [Reference Citation Analysis (0)]
99.  Wexner SD, Rothenberger DA, Jensen L, Goldberg SM, Balcos EG, Belliveau P, Bennett BH, Buls JG, Cohen JM, Kennedy HL. Ileal pouch vaginal fistulas: Incidence, etiology, and management. Dis Colon Rectum. 1989;32:460-465.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 77]  [Cited by in F6Publishing: 76]  [Article Influence: 2.2]  [Reference Citation Analysis (0)]
100.  Lee PY, Fazio VW, Church JM, Hull TL, Eu KW, Lavery IC. Vaginal fistula following restorative proctocolectomy. Dis Colon Rectum. 1997;40:752-759.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 73]  [Cited by in F6Publishing: 70]  [Article Influence: 2.7]  [Reference Citation Analysis (0)]
101.  Paye F, Penna C, Chiche L, Tiret E, Frileux P, Parc R. Pouch-related fistula following restorative proctocolectomy. Br J Surg. 1996;83:1574-1577.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 60]  [Cited by in F6Publishing: 57]  [Article Influence: 2.1]  [Reference Citation Analysis (0)]
102.  Zinicola R, Wilkinson KH, Nicholls RJ. Ileal pouch-vaginal fistula treated by abdominoanal advancement of the ileal pouch. Br J Surg. 2003;90:1434-1435.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 25]  [Cited by in F6Publishing: 26]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]
103.  Shah NS, Remzi F, Massmann A, Baixauli J, Fazio VW. Management and treatment outcome of pouch-vaginal fistulas following restorative proctocolectomy. Dis Colon Rectum. 2003;46:911-917.  [PubMed]  [DOI]  [Cited in This Article: ]
104.  Galandiuk S, Scott NA, Dozois RR, Kelly KA, Ilstrup DM, Beart RW, Wolff BG, Pemberton JH, Nivatvongs S, Devine RM. Ileal pouch-anal anastomosis. Reoperation for pouch-related complications. Ann Surg. 1990;212:446-52; discussion 452-4.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 145]  [Cited by in F6Publishing: 135]  [Article Influence: 4.1]  [Reference Citation Analysis (0)]
105.  Burke D, van Laarhoven CJ, Herbst F, Nicholls RJ. Transvaginal repair of pouch-vaginal fistula. Br J Surg. 2001;88:241-245.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 59]  [Cited by in F6Publishing: 64]  [Article Influence: 2.9]  [Reference Citation Analysis (0)]
106.  MacLean AR, Cohen Z, MacRae HM, O'Connor BI, Mukraj D, Kennedy ED, Parkes R, McLeod RS. Risk of small bowel obstruction after the ileal pouch-anal anastomosis. Ann Surg. 2002;235:200-206.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 143]  [Cited by in F6Publishing: 153]  [Article Influence: 7.3]  [Reference Citation Analysis (0)]
107.  Marcello PW, Roberts PL, Schoetz DJ, Coller JA, Murray JJ, Veidenheimer MC. Obstruction after ileal pouch-anal anastomosis: A preventable complication? Dis Colon Rectum. 1993;36:1105-1111.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 71]  [Cited by in F6Publishing: 70]  [Article Influence: 2.3]  [Reference Citation Analysis (0)]
108.  Kim CN. A Common Complication After an Ileal Pouch-Anal Anastomosis With a Loop Ileostomy in Patients With Ulcerative Colitis: Small Bowel Obstruction. Ann Coloproctol. 2018;34:57-58.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 1]  [Article Influence: 0.2]  [Reference Citation Analysis (0)]
109.  Michelassi F, Lee J, Rubin M, Fichera A, Kasza K, Karrison T, Hurst RD. Long-term functional results after ileal pouch anal restorative proctocolectomy for ulcerative colitis: A prospective observational study. Ann Surg. 2003;238:433-41; discussion 442-5.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 208]  [Cited by in F6Publishing: 221]  [Article Influence: 11.1]  [Reference Citation Analysis (0)]
110.  Farouk R, Pemberton JH, Wolff BG, Dozois RR, Browning S, Larson D. Functional outcomes after ileal pouch-anal anastomosis for chronic ulcerative colitis. Ann Surg. 2000;231:919-926.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 215]  [Cited by in F6Publishing: 221]  [Article Influence: 9.6]  [Reference Citation Analysis (0)]
111.  Hahnloser D, Pemberton JH, Wolff BG, Larson DR, Crownhart BS, Dozois RR. Results at up to 20 years after ileal pouch-anal anastomosis for chronic ulcerative colitis. Br J Surg. 2007;94:333-340.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 305]  [Cited by in F6Publishing: 314]  [Article Influence: 19.6]  [Reference Citation Analysis (0)]
112.  Heikens JT, de Vries J, van Laarhoven CJ. Quality of life, health-related quality of life and health status in patients having restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis: A systematic review. Colorectal Dis. 2012;14:536-544.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 61]  [Cited by in F6Publishing: 61]  [Article Influence: 5.5]  [Reference Citation Analysis (0)]
113.  Tiainen J, Matikainen M. Health-related quality of life after ileal J-pouch-anal anastomosis for ulcerative colitis: Long-term results. Scand J Gastroenterol. 1999;34:601-605.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 55]  [Cited by in F6Publishing: 55]  [Article Influence: 2.3]  [Reference Citation Analysis (0)]
114.  Halverson AL, Hull TL, Remzi F, Hammel JP, Schroeder T, Fazio VW. Perioperative resting pressure predicts long-term postoperative function after ileal pouch-anal anastomosis. J Gastrointest Surg. 2002;6:316-20; discussion 320-1.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 14]  [Article Influence: 0.7]  [Reference Citation Analysis (0)]
115.  Oresland T, Fasth S, Nordgren S, Akervall S, Hultén L. Pouch size: The important functional determinant after restorative proctocolectomy. Br J Surg. 1990;77:265-269.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 74]  [Cited by in F6Publishing: 61]  [Article Influence: 1.8]  [Reference Citation Analysis (0)]
116.  Sunde ML, Ricanek P, Øresland T, Jahnsen J, Naimy N, Færden AE. Determinants of optimal bowel function in ileal pouch-anal anastomosis - physiological differences contributing to pouch function. Scand J Gastroenterol. 2018;53:8-14.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 9]  [Cited by in F6Publishing: 8]  [Article Influence: 1.6]  [Reference Citation Analysis (0)]
117.  Tonelli F, Giudici F, Di Martino C, Scaringi S, Ficari F, Addasi R. Outcome after ileal pouch-anal anastomosis in ulcerative colitis patients: Experience during a 27-year period. ANZ J Surg. 2016;86:768-772.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 11]  [Cited by in F6Publishing: 12]  [Article Influence: 1.7]  [Reference Citation Analysis (0)]
118.  Helavirta I, Huhtala H, Hyöty M, Collin P, Aitola P. Restorative Proctocolectomy for Ulcerative Colitis in 1985-2009. Scand J Surg. 2016;105:73-77.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 14]  [Article Influence: 1.8]  [Reference Citation Analysis (0)]
119.  Rickard MJ, Young CJ, Bissett IP, Stitz R, Solomon MJ; Research Committee of the Colorectal Surgical Society of Australasia. Ileal pouch-anal anastomosis: The Australasian experience. Colorectal Dis. 2007;9:139-145.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 20]  [Cited by in F6Publishing: 18]  [Article Influence: 1.1]  [Reference Citation Analysis (0)]
120.  Rossi HL, Brand MI, Saclarides TJ. Anal complications after restorative proctocolectomy (J-pouch). Am Surg. 2002;68:628-630.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 37]  [Cited by in F6Publishing: 40]  [Article Influence: 2.0]  [Reference Citation Analysis (0)]
121.  Segal JP, Adegbola SO, Worley GHT, Sahnan K, Tozer P, Lung PFC, Faiz OD, Clark SK, Hart AL. A Systematic Review: The Management and Outcomes of Ileal Pouch Strictures. J Crohns Colitis. 2018;12:369-375.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 16]  [Cited by in F6Publishing: 15]  [Article Influence: 3.0]  [Reference Citation Analysis (0)]
122.  Lewis WG, Kuzu A, Sagar PM, Holdsworth PJ, Johnston D. Stricture at the pouch-anal anastomosis after restorative proctocolectomy. Dis Colon Rectum. 1994;37:120-125.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 93]  [Cited by in F6Publishing: 88]  [Article Influence: 3.0]  [Reference Citation Analysis (0)]
123.  Senapati A, Tibbs CJ, Ritchie JK, Nicholls RJ, Hawley PR. Stenosis of the pouch anal anastomosis following restorative proctocolectomy. Int J Colorectal Dis. 1996;11:57-59.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 42]  [Cited by in F6Publishing: 42]  [Article Influence: 1.6]  [Reference Citation Analysis (0)]
124.  Fazio VW, Tjandra JJ. Pouch advancement and neoileoanal anastomosis for anastomotic stricture and anovaginal fistula complicating restorative proctocolectomy. Br J Surg. 1992;79:694-696.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 92]  [Cited by in F6Publishing: 84]  [Article Influence: 2.7]  [Reference Citation Analysis (0)]
125.  Shen B, Lashner BA, Bennett AE, Remzi FH, Brzezinski A, Achkar JP, Bast J, Bambrick ML, Fazio VW. 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.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 127]  [Cited by in F6Publishing: 123]  [Article Influence: 6.5]  [Reference Citation Analysis (0)]
126.  Theodoropoulos GE, Choman EN, Wexner SD. Salvage procedures after restorative proctocolectomy: A systematic review and meta-analysis. J Am Coll Surg. 2015;220:225-42.e1.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 21]  [Cited by in F6Publishing: 22]  [Article Influence: 2.4]  [Reference Citation Analysis (0)]
127.  Meagher AP, Farouk R, Dozois RR, Kelly KA, Pemberton JH. J ileal pouch-anal anastomosis for chronic ulcerative colitis: Complications and long-term outcome in 1310 patients. Br J Surg. 1998;85:800-803.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 475]  [Cited by in F6Publishing: 450]  [Article Influence: 18.0]  [Reference Citation Analysis (0)]
128.  Rubinstein MC, Fisher RL. Pouchitis: Pathogenesis, diagnosis, and management. Gastroenterologist. 1996;4:129-133.  [PubMed]  [DOI]  [Cited in This Article: ]
129.  Shen B. Diagnosis and treatment of patients with pouchitis. Drugs. 2003;63:453-461.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 59]  [Cited by in F6Publishing: 63]  [Article Influence: 3.2]  [Reference Citation Analysis (0)]
130.  Ståhlberg D, Gullberg K, Liljeqvist L, Hellers G, Löfberg R. Pouchitis following pelvic pouch operation for ulcerative colitis. Incidence, cumulative risk, and risk factors. Dis Colon Rectum. 1996;39:1012-1018.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 198]  [Cited by in F6Publishing: 189]  [Article Influence: 7.0]  [Reference Citation Analysis (0)]
131.  Hurst RD, Molinari M, Chung TP, Rubin M, Michelassi F. Prospective study of the incidence, timing and treatment of pouchitis in 104 consecutive patients after restorative proctocolectomy. Arch Surg. 1996;131:497-500; discussion 501-2.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 202]  [Cited by in F6Publishing: 191]  [Article Influence: 7.1]  [Reference Citation Analysis (0)]
132.  Apel R, Cohen Z, Andrews CW, McLeod R, Steinhart H, Odze RD. Prospective evaluation of early morphological changes in pelvic ileal pouches. Gastroenterology. 1994;107:435-443.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 87]  [Cited by in F6Publishing: 89]  [Article Influence: 3.1]  [Reference Citation Analysis (0)]
133.  Barton JG, Paden MA, Lane M, Postier RG. Comparison of postoperative outcomes in ulcerative colitis and familial polyposis patients after ileoanal pouch operations. Am J Surg. 2001;182:616-620.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 58]  [Cited by in F6Publishing: 59]  [Article Influence: 2.7]  [Reference Citation Analysis (0)]
134.  Moskowitz RL, Shepherd NA, Nicholls RJ. An assessment of inflammation in the reservoir after restorative proctocolectomy with ileoanal ileal reservoir. Int J Colorectal Dis. 1986;1:167-174.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 285]  [Cited by in F6Publishing: 295]  [Article Influence: 8.0]  [Reference Citation Analysis (0)]
135.  Sandborn WJ, Tremaine WJ, Batts KP, Pemberton JH, Phillips SF. Pouchitis after ileal pouch-anal anastomosis: A Pouchitis Disease Activity Index. Mayo Clin Proc. 1994;69:409-415.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 550]  [Cited by in F6Publishing: 538]  [Article Influence: 18.6]  [Reference Citation Analysis (0)]
136.  Heuschen UA, Allemeyer EH, Hinz U, Autschbach F, Uehlein T, Herfarth C, Heuschen G. Diagnosing pouchitis: Comparative validation of two scoring systems in routine follow-up. Dis Colon Rectum. 2002;45:776-86; discussion 786-8.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 65]  [Cited by in F6Publishing: 67]  [Article Influence: 3.2]  [Reference Citation Analysis (0)]
137.  McLaughlin SD, Clark SK, Tekkis PP, Nicholls RJ, Ciclitira PJ. The bacterial pathogenesis and treatment of pouchitis. Therap Adv Gastroenterol. 2010;3:335-348.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 40]  [Cited by in F6Publishing: 40]  [Article Influence: 3.1]  [Reference Citation Analysis (0)]
138.  Mimura T, Rizzello F, Helwig U, Poggioli G, Schreiber S, Talbot IC, Nicholls RJ, Gionchetti P, Campieri M, Kamm MA. Four-week open-label trial of metronidazole and ciprofloxacin for the treatment of recurrent or refractory pouchitis. Aliment Pharmacol Ther. 2002;16:909-917.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 160]  [Cited by in F6Publishing: 156]  [Article Influence: 7.4]  [Reference Citation Analysis (0)]
139.  Madden MV, McIntyre AS, Nicholls RJ. Double-blind crossover trial of metronidazole versus placebo in chronic unremitting pouchitis. Dig Dis Sci. 1994;39:1193-1196.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 228]  [Cited by in F6Publishing: 211]  [Article Influence: 7.3]  [Reference Citation Analysis (0)]
140.  Shen B, Achkar JP, Lashner BA, Ormsby AH, Remzi FH, Brzezinski A, Bevins CL, Bambrick ML, Seidner DL, Fazio VW. A randomized clinical trial of ciprofloxacin and metronidazole to treat acute pouchitis. Inflamm Bowel Dis. 2001;7:301-305.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 256]  [Cited by in F6Publishing: 257]  [Article Influence: 11.7]  [Reference Citation Analysis (0)]
141.  Gosselink MP, Schouten WR, van Lieshout LM, Hop WC, Laman JD, Ruseler-van Embden JG. Eradication of pathogenic bacteria and restoration of normal pouch flora: Comparison of metronidazole and ciprofloxacin in the treatment of pouchitis. Dis Colon Rectum. 2004;47:1519-1525.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 60]  [Cited by in F6Publishing: 62]  [Article Influence: 3.3]  [Reference Citation Analysis (0)]
142.  Gionchetti P, Rizzello F, Venturi A, Brigidi P, Matteuzzi D, Bazzocchi G, Poggioli G, Miglioli M, Campieri M. Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: A double-blind, placebo-controlled trial. Gastroenterology. 2000;119:305-309.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1077]  [Cited by in F6Publishing: 1098]  [Article Influence: 47.7]  [Reference Citation Analysis (0)]
143.  Mimura T, Rizzello F, Helwig U, Poggioli G, Schreiber S, Talbot IC, Nicholls RJ, Gionchetti P, Campieri M, Kamm MA. Once daily high dose probiotic therapy (VSL#3) for maintaining remission in recurrent or refractory pouchitis. Gut. 2004;53:108-114.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 660]  [Cited by in F6Publishing: 685]  [Article Influence: 36.1]  [Reference Citation Analysis (0)]
144.  Liu Z, Song H, Shen B. Pouchitis: Prevention and treatment. Curr Opin Clin Nutr Metab Care. 2014;17:489-495.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 10]  [Cited by in F6Publishing: 10]  [Article Influence: 1.1]  [Reference Citation Analysis (0)]
145.  Viscido A, Habib FI, Kohn A, Papi C, Marcheggiano A, Pimpo MT, Vernia P, Cadau G, Caprilli R. Infliximab in refractory pouchitis complicated by fistulae following ileo-anal pouch for ulcerative colitis. Aliment Pharmacol Ther. 2003;17:1263-1271.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 75]  [Cited by in F6Publishing: 80]  [Article Influence: 4.0]  [Reference Citation Analysis (0)]
146.  Viazis N, Giakoumis M, Koukouratos T, Saprikis E, Anastasopoulos E, Al-Odat M, Kechagias G, Zacharakis G, Markoglou K, Gouma P, Karamanolis DG. One-year infliximab administration for the treatment of chronic refractory pouchitis. Ann Gastroenterol. 2011;24:290-293.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 39]  [Cited by in F6Publishing: 39]  [Article Influence: 3.9]  [Reference Citation Analysis (0)]
147.  Huguet M, Pereira B, Goutte M, Goutorbe F, Dubois A, Bommelaer G, Buisson A. Systematic Review With Meta-Analysis: Anti-TNF Therapy in Refractory Pouchitis and Crohn's Disease-Like Complications of the Pouch After Ileal Pouch-Anal Anastomosis Following Colectomy for Ulcerative Colitis. Inflamm Bowel Dis. 2018;24:261-268.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 62]  [Cited by in F6Publishing: 53]  [Article Influence: 10.6]  [Reference Citation Analysis (0)]
148.  Miglioli M, Barbara L, Di Febo G, Gozzetti G, Lauri A, Paganelli GM, Poggioli G, Santucci R. Topical administration of 5-aminosalicylic acid: A therapeutic proposal for the treatment of pouchitis. N Engl J Med. 1989;320:257.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 25]  [Cited by in F6Publishing: 28]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
149.  Prudhomme M, Dehni N, Dozois RR, Tiret E, Parc R. Causes and outcomes of pouch excision after restorative proctocolectomy. Br J Surg. 2006;93:82-86.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 77]  [Cited by in F6Publishing: 82]  [Article Influence: 4.8]  [Reference Citation Analysis (0)]
150.  Bach SP, Mortensen NJ. Ileal pouch surgery for ulcerative colitis. World J Gastroenterol. 2007;13:3288-3300.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in CrossRef: 55]  [Cited by in F6Publishing: 47]  [Article Influence: 2.9]  [Reference Citation Analysis (0)]
151.  Fazio VW, Tekkis PP, Remzi F, Lavery IC, Manilich E, Connor J, Preen M, Delaney CP. Quantification of risk for pouch failure after ileal pouch anal anastomosis surgery. Ann Surg. 2003;238:605-14; discussion 614-7.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 201]  [Cited by in F6Publishing: 209]  [Article Influence: 10.5]  [Reference Citation Analysis (0)]
152.  Lepistö A, Luukkonen P, Järvinen HJ. Cumulative failure rate of ileal pouch-anal anastomosis and quality of life after failure. Dis Colon Rectum. 2002;45:1289-1294.  [PubMed]  [DOI]  [Cited in This Article: ]
153.  Tan HT, Morton D, Connolly AB, Pringle W, White M, Keighley MR. Quality of life after pouch excision. Br J Surg. 1998;85:249-251.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 18]  [Cited by in F6Publishing: 15]  [Article Influence: 0.6]  [Reference Citation Analysis (0)]
154.  Lightner AL, Dattani S, Dozois EJ, Moncrief SB, Pemberton JH, Mathis KL. Pouch excision: Indications and outcomes. Colorectal Dis. 2017;19:912-916.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 36]  [Cited by in F6Publishing: 34]  [Article Influence: 5.7]  [Reference Citation Analysis (0)]
155.  Dehni N, Remacle G, Dozois RR, Banchini F, Tiret E, Parc R. Salvage reoperation for complications after ileal pouch-anal anastomosis. Br J Surg. 2005;92:748-753.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 46]  [Cited by in F6Publishing: 47]  [Article Influence: 2.6]  [Reference Citation Analysis (0)]
156.  Fonkalsrud EW, Bustorff-Silva J. Reconstruction for chronic dysfunction of ileoanal pouches. Ann Surg. 1999;229:197-204.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 57]  [Cited by in F6Publishing: 59]  [Article Influence: 2.5]  [Reference Citation Analysis (0)]
157.  Mathis KL, Dozois EJ, Larson DW, Cima RR, Wolff BG, Pemberton JH. Outcomes in patients with ulcerative colitis undergoing partial or complete reconstructive surgery for failing ileal pouch-anal anastomosis. Ann Surg. 2009;249:409-413.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 40]  [Cited by in F6Publishing: 42]  [Article Influence: 3.0]  [Reference Citation Analysis (0)]
158.  Shawki S, Belizon A, Person B, Weiss EG, Sands DR, Wexner SD. What are the outcomes of reoperative restorative proctocolectomy and ileal pouch-anal anastomosis surgery? Dis Colon Rectum. 2009;52:884-890.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 45]  [Cited by in F6Publishing: 41]  [Article Influence: 2.9]  [Reference Citation Analysis (0)]
159.  Tekkis PP, Heriot AG, Smith JJ, Das P, Canero A, Nicholls RJ. Long-term results of abdominal salvage surgery following restorative proctocolectomy. Br J Surg. 2006;93:231-237.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 65]  [Cited by in F6Publishing: 67]  [Article Influence: 3.9]  [Reference Citation Analysis (0)]
160.  MacLean AR, O'Connor B, Parkes R, Cohen Z, McLeod RS. Reconstructive surgery for failed ileal pouch-anal anastomosis: A viable surgical option with acceptable results. Dis Colon Rectum. 2002;45:880-886.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 74]  [Cited by in F6Publishing: 79]  [Article Influence: 3.8]  [Reference Citation Analysis (0)]
161.  Fazio VW, Wu JS, Lavery IC. Repeat ileal pouch-anal anastomosis to salvage septic complications of pelvic pouches: Clinical outcome and quality of life assessment. Ann Surg. 1998;228:588-597.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 89]  [Cited by in F6Publishing: 92]  [Article Influence: 3.7]  [Reference Citation Analysis (0)]
162.  Remzi FH, Fazio VW, Kirat HT, Wu JS, Lavery IC, Kiran RP. Repeat pouch surgery by the abdominal approach safely salvages failed ileal pelvic pouch. Dis Colon Rectum. 2009;52:198-204.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 66]  [Cited by in F6Publishing: 57]  [Article Influence: 4.1]  [Reference Citation Analysis (0)]
163.  Nguyen GC, Steinhart AH. Nationwide patterns of hospitalizations to centers with high volume of admissions for inflammatory bowel disease and their impact on mortality. Inflamm Bowel Dis. 2008;14:1688-1694.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 39]  [Cited by in F6Publishing: 28]  [Article Influence: 1.9]  [Reference Citation Analysis (0)]
164.  Duff SE, O'Dwyer ST, Hultén L, Willén R, Haboubi NY. Dysplasia in the ileoanal pouch. Colorectal Dis. 2002;4:420-429.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 32]  [Cited by in F6Publishing: 32]  [Article Influence: 1.5]  [Reference Citation Analysis (0)]
165.  Derikx LA, Nissen LH, Oldenburg B, Hoentjen F. Controversies in Pouch Surveillance for Patients with Inflammatory Bowel Disease. J Crohns Colitis. 2016;10:747-751.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 15]  [Cited by in F6Publishing: 12]  [Article Influence: 1.7]  [Reference Citation Analysis (0)]
166.  Kuiper T, Vlug MS, van den Broek FJ, Tytgat KM, van Eeden S, Fockens P, Bemelman WA, Dekker E. The prevalence of dysplasia in the ileoanal pouch following restorative proctocolectomy for ulcerative colitis with associated dysplasia. Colorectal Dis. 2012;14:469-473.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 18]  [Cited by in F6Publishing: 18]  [Article Influence: 1.6]  [Reference Citation Analysis (0)]
167.  Heppell J, Weiland LH, Perrault J, Pemberton JH, Telander RL, Beart RW. Fate of the rectal mucosa after rectal mucosectomy and ileoanal anastomosis. Dis Colon Rectum. 1983;26:768-771.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 98]  [Cited by in F6Publishing: 90]  [Article Influence: 2.3]  [Reference Citation Analysis (0)]
168.  Gullberg K, Lindforss U, Zetterquist H, Stålberg D, Reinholt FP, Veress B, Tribukait B, Olivecrona H, Löfberg R. Cancer risk assessment in long-standing pouchitis. DNA aberrations are rare in transformed neoplastic pelvic pouch mucosa. Int J Colorectal Dis. 2002;17:92-97.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 24]  [Cited by in F6Publishing: 26]  [Article Influence: 1.2]  [Reference Citation Analysis (0)]
169.  Mark-Christensen A, Erichsen R, Brandsborg S, Rosenberg J, Qvist N, Thorlacius-Ussing O, Hillingsø J, Pachler JH, Christiansen EG, Laurberg S. Long-term Risk of Cancer Following Ileal Pouch-anal Anastomosis for Ulcerative Colitis. J Crohns Colitis. 2018;12:57-62.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 25]  [Cited by in F6Publishing: 23]  [Article Influence: 4.6]  [Reference Citation Analysis (0)]
170.  Selvaggi F, Pellino G, Canonico S, Sciaudone G. Systematic review of cuff and pouch cancer in patients with ileal pelvic pouch for ulcerative colitis. Inflamm Bowel Dis. 2014;20:1296-1308.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 72]  [Cited by in F6Publishing: 56]  [Article Influence: 6.2]  [Reference Citation Analysis (0)]
171.  Cairns SR, Scholefield JH, Steele RJ, Dunlop MG, Thomas HJ, Evans GD, Eaden JA, Rutter MD, Atkin WP, Saunders BP, Lucassen A, Jenkins P, Fairclough PD, Woodhouse CR; British Society of Gastroenterology; Association of Coloproctology for Great Britain and Ireland. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut. 2010;59:666-689.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 819]  [Cited by in F6Publishing: 896]  [Article Influence: 68.9]  [Reference Citation Analysis (2)]
172.  Johnson P, Richard C, Ravid A, Spencer L, Pinto E, Hanna M, Cohen Z, McLeod R. Female infertility after ileal pouch-anal anastomosis for ulcerative colitis. Dis Colon Rectum. 2004;47:1119-1126.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 130]  [Cited by in F6Publishing: 132]  [Article Influence: 6.9]  [Reference Citation Analysis (0)]
173.  Olsen KO, Joelsson M, Laurberg S, Oresland T. Fertility after ileal pouch-anal anastomosis in women with ulcerative colitis. Br J Surg. 1999;86:493-495.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 137]  [Cited by in F6Publishing: 147]  [Article Influence: 6.1]  [Reference Citation Analysis (0)]
174.  Ørding Olsen K, Juul S, Berndtsson I, Oresland T, Laurberg S. Ulcerative colitis: Female fecundity before diagnosis, during disease, and after surgery compared with a population sample. Gastroenterology. 2002;122:15-19.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 271]  [Cited by in F6Publishing: 279]  [Article Influence: 13.3]  [Reference Citation Analysis (0)]
175.  Waljee A, Waljee J, Morris AM, Higgins PD. Threefold increased risk of infertility: A meta-analysis of infertility after ileal pouch anal anastomosis in ulcerative colitis. Gut. 2006;55:1575-1580.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 260]  [Cited by in F6Publishing: 269]  [Article Influence: 15.8]  [Reference Citation Analysis (0)]
176.  Rajaratnam SG, Eglinton TW, Hider P, Fearnhead NS. Impact of ileal pouch-anal anastomosis on female fertility: Meta-analysis and systematic review. Int J Colorectal Dis. 2011;26:1365-1374.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 130]  [Cited by in F6Publishing: 130]  [Article Influence: 10.8]  [Reference Citation Analysis (0)]
177.  Olsen KØ. Juul S, Bülow S, Järvinen HJ, Bakka A, Björk J, Oresland T, Laurberg S. Female fecundity before and after operation for familial adenomatous polyposis. Br J Surg. 2003;90:227-231.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 200]  [Cited by in F6Publishing: 205]  [Article Influence: 10.3]  [Reference Citation Analysis (0)]
178.  Bartels SA, DʼHoore A, Cuesta MA, Bensdorp AJ, Lucas C, Bemelman WA. Significantly increased pregnancy rates after laparoscopic restorative proctocolectomy: A cross-sectional study. Ann Surg. 2012;256:1045-1048.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 169]  [Cited by in F6Publishing: 179]  [Article Influence: 16.3]  [Reference Citation Analysis (0)]
179.  Beyer-Berjot L, Maggiori L, Birnbaum D, Lefevre JH, Berdah S, Panis Y. A total laparoscopic approach reduces the infertility rate after ileal pouch-anal anastomosis: A 2-center study. Ann Surg. 2013;258:275-282.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 163]  [Cited by in F6Publishing: 172]  [Article Influence: 17.2]  [Reference Citation Analysis (0)]
180.  Lee-Kong S, Kiran RP. Ongoing challenges and controversies in ulcerative colitis surgery. Expert Rev Gastroenterol Hepatol. 2016;10:187-191.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 6]  [Article Influence: 0.9]  [Reference Citation Analysis (0)]
181.  Pachler FR, Brandsborg SB, Laurberg S. Paradoxical Impact of Ileal Pouch-Anal Anastomosis on Male and Female Fertility in Patients With Ulcerative Colitis. Dis Colon Rectum. 2017;60:603-607.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 13]  [Article Influence: 2.2]  [Reference Citation Analysis (0)]
182.  Ravid A, Richard CS, Spencer LM, O'Connor BI, Kennedy ED, MacRae HM, Cohen Z, McLeod RS. Pregnancy, delivery, and pouch function after ileal pouch-anal anastomosis for ulcerative colitis. Dis Colon Rectum. 2002;45:1283-1288.  [PubMed]  [DOI]  [Cited in This Article: ]