Technical tips for reoperative pouch surgery

Abstract

The ileoanal pouch is the cornerstone of intestinal reconstruction after proctocolectomy in patients with ulcerative colitis, familial adenomatous polyposis, and selected other diseases of the colorectum. With successful surgery, patients avoid a conventional lifelong ileostomy and maintain a satisfying quality of life with acceptable bowel function. Complications during surgery or convalescence, however, can result in ileoanal pouch failure and lead to an unacceptably poor quality of life. Although pouch excision has been (and is still) an option for patients with pouch failure, modern advances have allowed for corrective surgical measures to be applied in circumstances of pouch failure in order to restore good function of the pouch and as an alternative to pouch excision with permanent ileostomy. Selecting patients suitable for the ileoanal pouch revision and properly performing the technical aspects of the surgery are two challenging feats that have a direct impact on outcomes and quality of life in this population. This section will focus on strategies to evaluate and select the correct patient for the ileoanal pouch revision, and how to surgically optimize a patient that has been selected as an appropriate candidate. Additionally, proper surgical technique of ileal pouch revision/reconstruction will be discussed.