ABSTRACT
This chapter highlights the indications for ileal pouch-anal anastomosis (IPAA), the many operative strategies in use along with operative technical aspects and the different types of pouch reservoirs with the indications for their use. It discusses short- and long-term follow-up data regarding pouch surgery, as well as strategies to salvage a dysfunctional pouch after the dreaded scenario of an IPAA leak or other complications. The initial description of restorative proctocolectomy, also commonly referred to as the IPAA, was published by A. G. Parks and R. J. Nicholls in 1978. The potential strategies are four in number: one-stage, traditional two-stage, modified two-stage and three-stage. The traditional two-stage strategy refers to initial proctocolectomy, IPAA and a diverting loop ileostomy in the same setting, with subsequent closure of the loop ileostomy around three months later. Prompt recognition and treatment of anastomotic disruption is paramount to preservation of IPAA function and avoidance of the known long-term sequelae of sepsis.
