Technical aspects and results of reconstructive proctocolectomy and ileoanal pouch procedure for ulcerative colitis

The continence preserving restorative protocolectomy is the operation of choice for ulcerative colitis. Many technical aspects of the J-pouch procedure have been standardised. We prefer the hand-sewn pouch-anal anastomoses and construct a protective ileostomy in most patients. Latter allows to carefully assess the sphincter function postoperatively and if necessary - to train the sphincter before restoring continence. The frequency of postoperative ileus is comparable to that after other major intraabdominal surgery. Septic pelvic complications occur in up to 10 % of patients and determine the longterm prognosis of pouch function. Following pouch reconstruction, the stool frequency remains increased (4-6 per day) and continence may be partially impaired especially at night. These consequences are accepted by most patients. Because the ileoanal pouch procedure is a difficult and complicated operation, it should be performed by experienced surgeons only.