Complications of the Ileal Pouch
In patients with ulcerative colitis or familial adenomatous polyposis, ileal pouch surgery is the preferred method for restoring continuity after total proctocolectomy. Pouch-related complications can impact quality of life, require multiple repeat interv
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Key Concepts • Pelvic sepsis after pouch surgery is associated with worse function and risks pouch failure. However, prompt management of early postoperative septic complications can preserve pouch function and increase pouch retention rates. • Technical challenges during pouch surgery include ensuring tension-free reach, preserving adequate blood flow to the pouch, and creating an appropriate diverting ileostomy. • A three-stage approach is recommended for patients who are malnourished, have severe active colitis, or are under treatment with larger doses of steroids or immunosuppressive medications in order to reduce pouch-related complications. • The potential diagnosis of Crohn’s disease should be considered in any patient presenting with fistulizing disease after pouch surgery as this affects management and prognosis. • Repeat ileal pouch-anal anastomosis using a revised pouch or a new pouch is a reasonable option for selected patients with pouch failure. • Mucosectomy at the time of a pouch-anal anastomosis does not prevent future dysplasia or cancer as islands of rectal mucosa may persist. • Women with ulcerative colitis who undergo total proctocolectomy have a higher rate of infertility than women treated non-operatively, although a laparoscopic approach may reduce this risk.
Introduction Ileal pouch-anal anastomosis (IPAA) is the preferred method for restoring gastrointestinal tract continuity after total proctocolectomy. While the majority of patients recover uneventfully from this operation, a proportion of patients develop complications that are unique to this procedure and deserve
specific consideration. Complications after pouch surgery can be grouped into septic versus non-septic-related complications (including mechanical issues); alternatively, IPAA complications can be conceptualized as intraoperative, early postoperative, and late postoperative (Table 51-1). Pouch-related complications can significantly affect functional outcomes and patients’ quality of life, require multiple corrective procedures, and result, ultimately, in pouch failure [1]. Understanding the possible pouch-related complications and consideration of these complications in the operating room during pouch creation can reduce the incidence of these adverse events. In the postoperative setting, it is important to promptly address complications to better preserve pouch function and to reduce the risk of pouch failure which may be defined as the need for construction of a permanent stoma with or without excision of the pouch [2]. Modifying risk factors and focusing on preoperative planning details can potentially reduce the incidence of complications after pouch surgery and hence facilitate pouch function and preservation. Preoperative risk factors associated with pouch failure include type of resection (performing a completion proctectomy rather than total proctocolectomy), type of anastomosis (hand-sewn rather than stapled), diagnosis of Crohn’s disease, and comorbidities [3]. Modifying risk factors to minimize risk of pouch failure s
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