Minireviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2016; 8(8): 556-563
Published online Aug 27, 2016. doi: 10.4240/wjgs.v8.i8.556
Restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis: A narrative review
Luigi Sofo, Paola Caprino, Franco Sacchetti, Maurizio Bossola
Luigi Sofo, Paola Caprino, Maurizio Bossola, Division of General Surgery, Catholic University of the Sacred Heart, 00168 Rome, Italy
Franco Sacchetti, Division of Gastroenterology, Catholic University of the Sacred Heart, 00168 Rome, Italy
Author contributions: All of the authors have made substantial contributions to the conception and design of the study, data acquisition, or data analysis and interpretation, drafting of the article or critically revising it for important intellectual content, final approval of the version to be submitted.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Maurizio Bossola, MD, Division of General Surgery, Catholic University of the Sacred Heart, Largo A. Gemelli, 8, 00168 Rome, Italy. maubosso@tin.it
Telephone: +39-6-30155485 Fax: +39-6-30155491
Received: February 20, 2016
Peer-review started: February 24, 2016
First decision: March 23, 2016
Revised: April 9, 2016
Accepted: May 17, 2016
Article in press: May 27, 2016
Published online: August 27, 2016
Processing time: 187 Days and 22.6 Hours
Abstract

Restorative proctocolectomy with ileal pouch-anal anastomosis (RP-IPAA) is the gold standard surgical treatment for ulcerative colitis. However, despite the widespread use of RP-IPAA, many aspects of this treatment still remain controversial, such as the approach (open or laparoscopic), number of stages in the surgery, type of pouch, and construction type (hand-sewn or stapled ileal pouch-anal anastomosis). The present narrative review aims to discuss current evidence on the short-, mid-, and long-term results of each of these technical alternatives as well as their benefits and disadvantages. A review of the MEDLINE, EMBASE, and Ovid databases was performed to identify studies published through March 2016. Few large, randomized, controlled studies have been conducted, which limits the conclusions that can be drawn regarding controversial issues. The available data from retrospective studies suggest that laparoscopic surgery has no clear advantages compared with open surgery and that one-stage RP-IPAA may be indicated in selected cases. Regarding 2- and 3-stage RP-IPAA, patients who underwent these surgeries differed significantly with respect to clinical and laboratory variables, making any comparisons extremely difficult. The long-term results regarding the pouch type show that the W- and J-reservoirs do not differ significantly, although the J pouch is generally preferred by surgeons. Hand-sewn and stapled ileal pouch-anal anastomoses have their own advantages, and there is no clear benefit of one technique over the other.

Keywords: Ulcerative colitis; Total proctocolectomy; Ileal pouch; Anal anastomosis; Surgery; Laparoscopic

Core tip: Restorative proctocolectomy with ileal pouch-anal anastomosis (RP-IPAA) is the preferred surgical treatment for ulcerative colitis. However, despite the widespread use of RP-IPAA, many aspects of this treatment still remain controversial, such as the approach (open or laparoscopic), number of stages of surgery, type of pouch, and type of construction (e.g., hand-sewn or stapled ileal pouch-anal anastomosis). Few large, randomized, controlled studies have been conducted, which limits the conclusions that can be drawn regarding controversial issues associated with RP-IPAA. It is suggested that prospective, randomized studies should be conducted in the future to compare the frequency of post-operative complications, cosmetic results, short- and long-term functional outcomes, and quality of life associated with the available techniques of RT-IPAA for the treatment of ulcerative colitis.