Ileoanal pouch

Abstract

Proctocolectomy with an ileoanal pouch is the procedure of choice for a variety of underlying diseases, such as ulcerative colitis, classical familial adenomatous polyposis (FAP) and other polyposis syndromes or conditions with multiple synchronous cancers involving the rectum. Recently the indications for Crohn’s colitis and slow transit constipation are being revisited. Since the first description of the procedure in 1978 by Parks and Nicholls with an S‑pouch and the J‑pouch by Utsunomiya in 1983, the latter has become the overall recommended standard. Multiple procedural details are not described in the literature; however, these may contribute to important differences in functional outcome. The methodology varies with the recommended one, two and three-stage procedures and also in being performed conventionally or laparoscopically. Additionally, since the introduction of taTME for rectal cancer, a retake of the discussion regarding the most recommendable ileal pouch-anal anastomosis has evolved. In this article we describe our technical approach for a one-stage procedure of laparoscopic proctocolectomy. It has become our strategy of choice to defer from routine ileostomy and to perform the rectal resection as transanal laparoscopic total mesorectal excision (taTME). Additionally, perioperative management, outcome and the current literature are discussed. The report is illustrated with pictures of a 26-year-old female patient with FAP and profuse distal polyposis reaching the supra-anal level.