Restorative Proctocolectomy–Technical Challenges of the Ileal Pouch-Anal Procedure for Ulcerative Colitis and Familial Adenomatous Polyposis

Following the introduction of the operation of proctocolectomy with the use of an ileal pouch to function as a reservoir, restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has been considered by most patients and surgeons to be the ideal surgical procedure for the majority of patients with chronic ulcerative colitis and familial adenomatous polyposis (FAP). The operation offers a good quality of life in many patients and, when successful, avoids the need for a permanent ileostomy with the associated psychological, physical and social problems associated with a permanent stoma. However, whilst most patients obtain a good functional result there remains a significant morbidity associated with the operation and the future potential for recurrent symptoms from conditions such as pouchitis (1).