Ileal-Pouch Anal Anastomosis (Restorative Proctocolectomy)
 
The ileal-pouch anal anastomosis (IPAA) is an operation designed to allow bowel movements through the anus after removal of the entire large bowel and most of the rectum. A straight connection of the small bowel to the anus is undesirable because it results in a high frequency of bowel movements.
 
By creating a pouch with the end of the small bowel (ileum) the frequency of bowel movements is reduced to an acceptable level. Other names for the procedure include: ileo-anal procedure, ileo-anal anastomosis, ileo-anal pull-through, pull-through procedure, Soave procedure, "J", "S" or "W" pouch.
 
The IPAA was first described by a British surgeon in 1976 and perfected by a Japanese surgeon in 1980. During the 1980s many surgeons made substantial contributions to our present understanding of this operation.
 
We now realize that patients undergoing the IPAA have better results when a multidisciplinary team of professionals with experience in this procedure, cares for them and when the patient and family have a clear understanding of the unique features of the IPAA. Nine out of ten patients have this operation as the treatment for ulcerative colitis. With much less frequency, the IPAA is performed for patients with indeterminate colitis and familial polyposis.
 
 
The IPAA consists of the creation of an ileal pouch and a connection of the pouch to the anus. The entire operation, including the colectomy and the IPAA, can be done at one time or it can be staged in different operations depending on the initial severity of the colitis.
 
Leakage of stool from the connection of the pouch to the anus is the most feared complication. In patients who may be at higher risk of developing leakage because of poor nutrition, high dose of steroids or severe colitis, a temporary ileostomy is created to keep stool away from the IPAA while it heals.
 
In a second operation, the ileostomy is closed and stool is allowed to flow through the anus. The IPAA can be done either through the traditional open approach or laparoscopically.  Either way the IPAA is a long operation, about 6 hours on the average.  The laparoscopic approach may have some benefits in terms of cosmesis (smaller incisions mostly in the lower abdomen); however, it has not resulted in fewer days of hospital stay which is usually around 6 days.

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