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World J Gastroenterol. Oct 7, 2014; 20(37): 13211-13218
Published online Oct 7, 2014. doi: 10.3748/wjg.v20.i37.13211
Surgical treatment of ulcerative colitis: Ileorectal vs ileal pouch-anal anastomosis
Daniele Scoglio, Usama Ahmed Ali, Alessandro Fichera
Daniele Scoglio, Alessandro Fichera, Department of Surgery, University of Washington Medical Center, Seattle, WA 98195, Unites States
Usama Ahmed Ali, Department of Surgery, University Medical Center Utrecht, 3508 CX, Utrecht, The Netherlands
Author contributions: Scoglio D, Ahmed Ali U and Fichera A contributed equally to conception and design of the paper; Scoglio D and Ahmed Ali U were responsible for searching the literature, interpreting data and drafting the article; Fichera A was responsible for revising the article critically for the important intellectual content and gave final approval of the version to be submitted.
Correspondence to: Usama Ahmed Ali, MD, MSc, Department of Surgery, University Medical Center Utrecht, Room G04.228, PO Box 85500, 3508 CX, Utrecht, The Netherlands. u.ahmedali@umcutrecht.nl
Telephone: +31-88-7556489 Fax: +31-30-2541944
Received: March 3, 2014
Revised: April 19, 2014
Accepted: May 26, 2014
Published online: October 7, 2014
Abstract

Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the current gold standard in the surgical treatment of ulcerative colitis (UC) refractory to medical management. A procedure of significant magnitude carries its own risks including anastomotic failure, pelvic sepsis and a low rate of neoplastic degeneration overtime. Recent studies have shown that total colectomy with ileorectal anastomosis (IRA) has been associated with good long-term functional results in a selected group of UC patients amenable to undergo a strict surveillance for the relatively high risk of cancer in the rectum. This manuscript will review and compare the most recent literature on IRA and IPAA as it pertains to postoperative morbidity and mortality, failure rates, functional outcomes and cancer risk.

Keywords: Ulcerative colitis, Ileorectal anastomosis, Ileal pouch-anal anastomosis, Retained rectum, Neoplastic degeneration

Core tip: Ileal pouch-anal anastomosis (IPAA) is the most commonly performed procedure for treatment of UC patients refractory to medical therapy. However, IPAA carries on its own risks. Recently, some authors have proposed ileorectal anastomosis (IRA) as a valid surgical alternative to IPAA. IRA is an easier operation than IPAA associated with low complication rates and comparable long-term functional results. This manuscript reviews the pros and cons of both procedures and compares results.