Ileal Pouch-Anal Anastomosis for Indeterminate Colitis and Crohn's Disease

Abstract

Although ileal pouch-anal anastomosis (IPAA) is the standard of care surgery for patients with ulcerative colitis, the role of this procedure in patients with indeterminate colitis and Crohn's disease (CD) is more controversial. Recent studies have shown no significant adverse surgical outcome of IPAA in patients with indeterminate colitis. The outcome of IPAA in patients with CD seems to depend on when the diagnosis of CD is established. Although Crohn's colitis patients with bowel inflammation and/or anal disease should not be encouraged to have an IPAA, carefully selected CD patients without small-bowel inflammation or anal disease may safely undergo an IPAA. Patients in whom the diagnosis of CD is made on the basis of the resected colon fare well after IPAA. CD that develops months or years after IPAA has an aggressive disease course, and it seems to respond favorably to biological therapies such as infliximab.