The ABC's of re-do ileoanal pouches, what every gastroenterologist should know.

Abstract

To describe the development of re-do pouch surgery, what it entails, its indications and role in the management of patients with inflammatory bowel disease. Re-do pouch surgery has very good outcomes and excellent patient satisfaction when performed on carefully selected patients in specialized centers. The ileal pouch anal anastomosis (IPAA) procedure, which was developed 40 years ago, is a mainstay in the reconstruction of patients who undergo a proctoclectomy for ulcerative colitis and familial adenomatous polyposis (FAP). It allows these patients to avoid a permanent ileostomy, with the majority having a very good quality of life and functional outcomes. Unfortunately, a small but not insignificant number of patients will develop technical complications that may severely affect their quality of life and function of the pouch. In the past, pouch excision with permanent diversion or Koch pouch were the only option available to these patients. Recent advances have resulted in the development of corrective surgical measures to restore pouch function. We will discuss strategies to evaluate and select the right patients for a re-do pouch surgery, how to surgically optimize them, and describe the proper technique of ileal pouch revision and reconstruction.