Patient Selection

  • Michael Powar
  • Justin Davies


Patient selection, including active patient involvement, is of paramount importance in the setting of ileal pouch-anal anastomosis (IPAA) surgery. In the following chapter, we discuss the indications for surgery and key patient, disease and surgical considerations.


Ileal pouch anal anastomosis Ileoanal pouch Inflammatory bowel disease Dysplasia Colorectal cancer Patient selection 


  1. 1.
    Carter MJ, Lobo AJ, Travis SP, IBD Section BSoG. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2004;53:V1–16.PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Samuel S, Ingle SB, Dhillon S, et al. Cumulative incidence and risk factors for hospitalization and surgery in a population-based cohort of ulcerative colitis. Inflamm Bowel Dis. 2013;19:1858–66.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Truelove SC, Witts LJ. Cortisone in ulcerative colitis; final report on a therapeutic trial. Br Med J. 1955;2:1041–8.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Bernstein CN, Ng SC, Lakatos PL, Moum B, Loftus EV Jr. A review of mortality and surgery in ulcerative colitis: milestones of the seriousness of the disease. Inflamm Bowel Dis. 2013;19:2001–10.PubMedGoogle Scholar
  5. 5.
    Oresland T, Bemelman WA, Sampietro GM, et al. European evidence based consensus on surgery for ulcerative colitis. J Crohns Colitis. 2015;9:4–25.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Oshitani N, Kitano A, Matsumoto T, Kobayashi K. Corticosteroids for the management of ulcerative colitis. J Gastroenterol. 1995;30(suppl 8):118–20.PubMedGoogle Scholar
  7. 7.
    Campbell S, Travis S, Jewell D. Ciclosporin use in acute ulcerative colitis: a long-term experience. Eur J Gastroenterol Hepatol. 2005;17:79–84.PubMedCrossRefGoogle Scholar
  8. 8.
    Moskovitz DN, Van Assche G, Maenhout B, et al. Incidence of colectomy during long-term follow-up after cyclosporine-induced remission of severe ulcerative colitis. Clin Gastroenterol Hepatol. 2006;4:760–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Ziv Y, Fazio VW, Church JM, Milsom JW, Schroeder TK. Safety of urgent restorative proctocolectomy with ileal pouch- anal anastomosis for fulminant colitis. Dis Colon Rectum. 1995;38:345–9.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Harms BA, Myers GA, Rosenfeld DJ, Starling JR. Management of fulminant ulcerative colitis by primary restorative proctocolectomy. Dis Colon Rectum. 1994;37:971–8.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Teeuwen PH, Stommel MW, Bremers AJ, van der Wilt GJ, de Jong DJ, Bleichrodt RP. Colectomy in patients with acute colitis: a systematic review. J Gastrointest Surg. 2009;13:676–86.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Marceau C, Alves A, Ouaissi M, Bouhnik Y, Valleur P, Panis Y. Laparoscopic subtotal colectomy for acute or severe coli- tis complicating inflammatory bowel disease: a case-matched study in 88 patients. Surgery. 2007;141:640–4.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Chung TP, Fleshman JW, Birnbaum EH, Hunt SR, Dietz DW, Read TE, et al. Laparoscopic vs. open total abdominal colectomy for severe colitis: impact on recovery and subsequent completion restorative proctocolectomy. Dis Colon Rectum. 2009;52:4–10.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Carter FM, McLeod RS, Cohen Z. Subtotal colectomy for ulcerative colitis: complications related to the rectal remnant. Dis Colon Rectum. 1991;34:1005–9.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Gu J, Stocchi L, Remzi F, Kiran RP. Intraperitoneal or subcutaneous: does location of the (colo)rectal stump influence outcomes after laparoscopic total abdominal colectomy for ulcerative colitis? Dis Colon Rectum. 2013;56:615–21.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Trickett JP, Tilney HS, Gudgeon AM, Mellor SG, Edwards DP. Management of the rectal stump after emergency sub-total colectomy: which surgical option is associated with the lowest morbidity? Colorectal Dis. 2005;7:519–22.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Karch LA, Bauer JJ, Gorfine SR, Gelernt IM. Subtotal colectomy with hartmann’s pouch for inflammatory bowel disease. Dis Colon Rectum. 1995;38:635–9.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Fazio VW, Tekkis PP, Remzi F, et al. Quantification of risk for pouch failure after ileal pouch anal anastomosis surgery. Ann Surg. 2003;238:605–14.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Metcalf AM. Elective and emergent operative management of ulcerative colitis. Surg Clin North Am. 2007;87:633–41.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Jimmo B, Hyman NH. Is ileal pouch-anal anastomosis really the procedure of choice for patients with ulcerative colitis? Dis Colon Rectum. 1998;41:41–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Carlstedt A, Fasth S, Hultén L, Nordgren S, Palselius I. Long- term ileostomy complications in patients with ulcerative colitis and Crohn’s disease. Int J Colorectal Dis. 1987;2:22–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Fazio VW, Ziv Y, Church JM, et al. Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg. 1995;222:120–7.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Meagher AP, Farouk R, Dozois RR, Kelly KA, Pemberton JH. J ileal pouch-anal anastomosis for chronic ulcerative colitis: complications and long-term outcome in 1310 patients. Br J Surg. 1998;85:800–18.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    McIntyre PB, Pemberton JH, Wolff BG, Beart RW, Dozois RR. Comparing functional results one year and ten years after ileal pouch-anal anastomosis for chronic ulcerative colitis. Dis Colon Rectum. 1994;37:303–7.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Leowardi C, Hinz U, Tariverdian M, et al. Long-term outcome 10 years or more after restorative proctocolectomy and ileal pouch-anal anastomosis in patients with ulcerative colitis. Langenbecks Arch Surg. 2010;395:49–56.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Tiainen J, Matikainen M. Health-related quality of life after ileal J-pouch-anal anastomosis for ulcerative colitis: long-term results. Scand J Gastroenterol. 1999;34:601–5.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Carmon E, Keidar A, Ravid A, Goldman G, Rabau M. The correlation between quality of life and functional outcome in ulcerative colitis patients after proctocolectomy ileal pouch anal anastomosis. Colorectal Dis. 2003;5:228–32.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Itzkowitz SH, Yio X. Inflammation and cancer iV. Colorectal cancer in inflammatory bowel disease: the role of inflammation. Am J Physiol Liver Physiol. 2004;287:G7–G17.CrossRefGoogle Scholar
  29. 29.
    Breynaert C, Vermeire S, Rutgeerts P, Van Assche G. Dysplasia and colorectal cancer in inflammatory bowel disease: a result of inflammation or an intrinsic risk? Acta Gastroenterol Belg. 2008;71:367–72.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Shapiro BD, Lashner BA. Cancer biology in ulcerative colitis and potential use in endoscopic surveillance. Gastrointest Endosc Clin N Am. 1997;7:453–68.PubMedCrossRefGoogle Scholar
  31. 31.
    Taylor BA, Wolff BG, Dozois RR, Kelly KA, Pemberton JH, Beart RW Jr. Ileal pouch-anal anastomosis for chronic ulcerative colitis and familial polyposis coli complicated by adenocarcinoma. Dis Colon Rectum. 1988;31:358–62.PubMedCrossRefGoogle Scholar
  32. 32.
    Merchea A, Wolff BG, Dozois EJ, Abdelsattar ZM, Harmsen WS, Larson DW. Clinical features and oncologic outcomes in 77 patients with rectal cancer and ulcerative colitis: a single-institution experience. Dis Colon Rectum. 2012;55:881–5.PubMedCrossRefGoogle Scholar
  33. 33.
    Gorfine SR, Harris MT, Bub DS, Bauer JJ. Restorative proctocolectomy for ulcerative colitis complicated by colorectal cancer. Dis Colon Rectum. 2004;47:1377–85.PubMedCrossRefGoogle Scholar
  34. 34.
    Penna C, Tiret E, Daude F, Parc R. Results of ileal J-pouch-anal anastomosis in familial adenomatous polyposis complicated by rectal carcinoma. Dis Colon Rectum. 1994;37:157–60.PubMedCrossRefGoogle Scholar
  35. 35.
    Radice E, Nelson H, Devine RM, Dozois RR, Nivatvongs S, Pemberton JH, Wolff BG, Fozard BJ, Ilstrup D. Ileal pouch- anal anastomosis in patients with colorectal cancer: long-term functional and oncologic outcomes. Dis Colon Rectum. 1998;41:11–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Remzi FH, Preen M. Rectal cancer and ulcerative colitis: does it change the therapeutic approach? Colorectal Dis. 2003;5:483–5.PubMedCrossRefGoogle Scholar
  37. 37.
    Stelzner M, Fonkalsrud EW. The endorectal ileal pullthrough procedure in patients with ulcerative colitis and familial polyposis with carcinoma. Surg Gynecol Obstet. 1989;169:187–94.PubMedGoogle Scholar
  38. 38.
    Wiltz O, Hashmi HF, Schoetz DJ Jr, Roberts PL, Murray JJ, Coller JA, Veidenheimer MC. Carcinoma and the ileal pouch-anal anastomosis. Dis Colon Rectum. 1991;34:805–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Ziv Y, Fazio VW, Strong SA, Oakley JR, Milsom JW, Lavery IC. Ulcerative colitis and coexisting colorectal cancer: recurrence rate after restorative proctocolectomy. Ann Surg Oncol. 1994;1:512–5.PubMedCrossRefGoogle Scholar
  40. 40.
    Ziv Y, Church JM, Oakley JR, McGannon E, Schroeder TK, Fazio VF. Results after restorative proctocolectomy and ileal pouch- anal anastomosis in patients with familial adenomatous polyposis and coexisting colorectal cancer. Br J Surg. 1996;83:1578–80.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Jung H, Beck-Bornholdt HP, Svoboda V, Alberti W, Herrmann T. Quantification of late complications after radiation therapy. Radiother Oncol. 2001;61:233–46.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Snelgrove R, Brown CJ, O’Connor BI, Huang H, Victor JC, Gryfe R, MacRae H, Cohen Z, McLeod RS. Proctocolectomy for colorectal cancer--is the ileal pouch anal anastomosis a safe alternative to permanent ileostomy? Int J Colorectal Dis. 2014;29(12):1485–91.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Heppell J, Weiland LH, Perrault J, Pemberton JH, Telander RL, Beart RW Jr. Fate of the rectal mucosa after rectal mucosectomy and ileoanal anastomosis. Dis Colon Rectum. 1983;26:768–71.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Setti-Carraro P, Ritchie JK, Wilkinson KH, Nicholls RJ, Hawley PR. The first 10 years’ experience of restorative proctocolectomy for ulcerative colitis. Gut. 1994;35(8):1070–5.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Lewis WG, Sagar PM, Holdsworth PJ, Axon AT, Johnston D. Restorative proctocolectomy with end to end pouch-anal anastomosis in patients over the age of fifty. Gut. 1993;34:948–52.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Dayton MT, Larsen KR. Should older patients undergo ileal pouch-anal anastomosis? Am J Surg. 1996;172:444–7.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Reissman P, Teoh TA, Weiss EG, Nogueras JJ, Wexner SD. Functional outcome of the double stapled ileoanal reservoir in patients more than 60 years of age. Am Surg. 1996;62:178–83.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Bauer JJ, Gorfine SR, Gelernt IM, Harris MT, Kreel I. Restorative proctocolectomy in patients older than fifty years. Dis Colon Rectum. 1997;40:562–5.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Tan HT, Connolly AB, Morton D, Keighley MR. Results of restorative proctocolectomy in the elderly. Int J Colorectal Dis. 1997;12:319–22.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Takao Y, Gilliland R, Nogueras JJ, Weiss EG, Wexner SD. Is age relevant to functional outcome after restorative proctocolectomy for ulcerative colitis?: prospective assessment of 122 cases. Ann Surg. 1998;227:187–94.PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Delaney CP, Fazio VW, Remzi FH, et al. Prospective, age- related analysis of surgical results, functional outcome, and quality of life after ileal pouch-anal anastomosis. Ann Surg. 2003;238:221–8.PubMedPubMedCentralGoogle Scholar
  52. 52.
    Farouk R, Pemberton JH, Wolff BG, Dozois RR, Browning S, Larson D. Functional outcomes after ileal pouch-anal anastomosis for chronic ulcerative colitis. Ann Surg. 2000;231:919–26.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    Ramage L, Qiu S, Georgiou P, et al. Functional outcomes following ileal pouch-anal anastomosis (IPAA) in older patients: a systematic review. Int J Colorectal Dis. 2016;31:481–92.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 54.
    Hubbard RE, Story DA. Patient frailty: the elephant in the operating room. Anaesthesia. 2014;69:26–34.PubMedCrossRefPubMedCentralGoogle Scholar
  55. 55.
    Cohan JN, Bacchetti P, Varma MG, Finlayson E. Outcomes after ileoanal pouch surgery in frail and older adults. J Surg Res. 2015;198:327–33.PubMedCrossRefPubMedCentralGoogle Scholar
  56. 56.
    Ross H, Steele SR, Varma M, Dykes S, Cima R, Buie WD, Rafferty J, Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the surgical treatment of ulcerative colitis. Dis Colon Rectum. 2014;57(1):5–22.PubMedCrossRefPubMedCentralGoogle Scholar
  57. 57.
    Long MD, Crandall WV, Leibowitz IH, Duffy L, del Rosario F, Kim SC, Integlia MJ, Berman J, Grunow J, Colletti RB, Schoen BT, Patel AS, Baron H, Israel E, Russell G, Ali S, Herfarth HH, Martin C, Kappelman MD. Prevalence and epidemiology of overweight and obesity in children with inflammatory bowel disease. Inflamm Bowel Dis. 2011;17:2162–8.PubMedCrossRefPubMedCentralGoogle Scholar
  58. 58.
    Efron JE, Uriburu JP, Wexner SD, Pikarsky A, Hamel C, Weiss EG, Nogueras JJ. Restorative proctocolectomy with ileal pouch anal anastomosis in obese patients. Obes Surg. 2001;11:246–51.PubMedCrossRefPubMedCentralGoogle Scholar
  59. 59.
    Kiran RP, Remzi FH, Fazio VW, Lavery IC, Church JM, Strong SA, Hull TL. Complications and functional results after ileoanal pouch formation in obese patients. J Gastrointest Surg. 2008;12:668–74.PubMedCrossRefPubMedCentralGoogle Scholar
  60. 60.
    Canedo JA, Pinto RA, McLemore EC, Rosen L, Wexner SD. Restorative proctectomy with ileal pouch–anal anastomosis in obese patients. Dis Colon Rectum. 2010;53:1030–4.PubMedCrossRefGoogle Scholar
  61. 61.
    Klos CL, Safar B, Jamal N, et al. Obesity increases risk for pouch-related complications following restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). J Gastrointest Surg. 2014;18:573–9.PubMedCrossRefGoogle Scholar
  62. 62.
    Ferrante M, D’Hoore A, Vermeire S, Declerck S, Noman M, Van Assche G, et al. Corticosteroids but not infliximab increase short-term postoperative infectious complications in patients with ulcerative colitis. Inflamm Bowel Dis. 2009;15:1062–70.PubMedCrossRefGoogle Scholar
  63. 63.
    Mahadevan U, Loftus WJ Jr, Tremaine EV, Pemberton JH, Harmsen WS, Schleck CD, et al. Azathioprine or 6-mercaptopurine before colectomy for ulcerative colitis is not associated with increased postoperative complications. Inflamm Bowel Dis. 2002;8:311–6.PubMedCrossRefGoogle Scholar
  64. 64.
    Mor IJ, Vogel JD, da Luz Moreira A, Shen B, Hammel J, Remzi FH. Infliximab in ulcerative colitis is associated with an increased risk of post- operative complications after restorative proctocolectomy. Dis Colon Rectum. 2008;51:1202–12077–10.CrossRefGoogle Scholar
  65. 65.
    Selvasekar CR, Cima RR, Larson DW, Dozois EJ, Harrington JR, Harmsen WS, et al. Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis. J Am Coll Surg. 2007;204:956–96262–3.PubMedCrossRefGoogle Scholar
  66. 66.
    Gainsbury ML, Chu DI, Howard LA, Coukos JA, Farraye FA, Stucchi AF, et al. Preoperative infliximab is not associated with an increased risk of short-term postoperative complications after restorative proctocolectomy and ileal pouch-anal anastomosis. J Gastrointest Surg. 2011;15:397–403.PubMedCrossRefGoogle Scholar
  67. 67.
    Bregnbak D, Mortensen C, Bendtsen F. Infliximab and complications after colectomy in patients with ulcerative colitis. J Crohns Colitis. 2012;6:281–6.PubMedCrossRefGoogle Scholar
  68. 68.
    Eshuis EJ, Al Saady RL, Stokkers PC, Ponsioen CY, Tanis PJ, Bemelman WA. Previous infliximab therapy and postoperative complications after proctocolectomy with ileum pouch anal anastomosis. J Crohns Colitis. 2013;7:142–9.PubMedCrossRefGoogle Scholar
  69. 69.
    Pavlides M, Cleland J, Rahman M, et al. Outcomes after ileal pouch anal anastomosis in patients with primary sclerosing cholangitis. J Crohns Colitis. 2014;8:662–70.PubMedCrossRefPubMedCentralGoogle Scholar
  70. 70.
    Delaney CP, Remzi FH, Gramlich T, Dadvand B, Fazio VW. Equivalent function, quality of life and pouch survival rates after ileal-pouch anal anastomosis for indeterminate colitis and ulcerative colitis. Ann Surg. 2002;236:43–8.PubMedPubMedCentralCrossRefGoogle Scholar
  71. 71.
    Tekkis PP, Heriot AG, Smith O, Smith JJ, Windsor ACJ, Nicholls RJ. Long-term outcomes of restorative proctolectomy for Crohn’s disease and indeterminate colitis. Colorectal Dis. 2005;7:218–23.PubMedCrossRefPubMedCentralGoogle Scholar
  72. 72.
    Antolovic D, Kienle P, Knaebel HP, Schmidt J, Gutt CN, Weitz J, et al. Totally laparoscopic versus conventional ileoanal pouch procedure– design of a single-centre, expertise based randomised controlled trial to compare the laparoscopic and conventional surgical approach in patients undergoing primary elective restorative proctocolectomy–LapConPouch- Trial. BMC Surg. 2006;6:13.PubMedPubMedCentralCrossRefGoogle Scholar
  73. 73.
    Tilney HS, Lovegrove RE, Heriot AG, Purkayastha S, Constantinides V, Nicholls RJ, et al. Comparison of short-term outcomes of laparoscopic vs open approaches to ileal pouch surgery. Int J Colorectal Dis. 2007;22:531–42.PubMedCrossRefGoogle Scholar
  74. 74.
    Causey MW, Stoddard D, Johnson EK, et al. Laparoscopy impacts outcomes favourably following colectomy for ulcerative colitis: a critical analysis of the ACS-NSQIP database. Surg Endosc. 2013;27:603–9.PubMedCrossRefGoogle Scholar
  75. 75.
    Ahmed AU, Keus F, Heikens JT, Bemelman WA, Berdah SV, Gooszen HG, et al. Open versus laparoscopic (assisted) ileo pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis. Cochrane Database Syst Rev. 2009;CD006267.Google Scholar
  76. 76.
    Dunker MS, Bemelman WA, Slors JF, van Duijvendijk P, Gouma DJ. Functional outcome, quality of life, body image, and cosmesis in patients after laparoscopic-assisted and conventional restorative proctocolectomy: a comparative study. Dis Colon Rectum. 2001;44:1800–7.PubMedCrossRefGoogle Scholar
  77. 77.
    Fajardo AD, Dharmarajan S, George V, et al. Laparoscopic versus open 2-stage ileal pouch: laparoscopic approach allows for faster restoration of intestinal continuity. J Am Coll Surg. 2010;211:377–83.PubMedCrossRefGoogle Scholar
  78. 78.
    Hull TL, Joyce MR, Geisler DP, Coffey JC. Adhesions after laparoscopic and open ileal pouch-anal anastomosis surgery for ulcerative colitis. Br J Surg. 2012;99:270–5.PubMedCrossRefGoogle Scholar
  79. 79.
    Bartels SA, D’Hoore A, Cuesta MA, Bensdorp AJ, Lucas C, Bemelman WA. Significantly increased pregnancy rates after laparoscopic restorative proctocolectomy: a cross-sectional study. Ann Surg. 2012;256:1045–8.PubMedCrossRefGoogle Scholar
  80. 80.
    Beyer-Berjot L, Maggiori L, Birnbaum D, Lefevre JH, Berdah S, Panis Y. A total laparoscopic approach reduces the infertility rate after ileal pouch-anal anastomosis: a 2-center study. Ann Surg. 2013;258(2):275–82.PubMedCrossRefPubMedCentralGoogle Scholar
  81. 81.
    Arbuthnot LW. The results of operative treatment of chronic constipation. BMJ. 1908;1:126–30.CrossRefGoogle Scholar
  82. 82.
    Preston DM, Hawley PR, Lennard-Jones JE, et al. Results of colectomy for severe idiopathic constipation in women (Arbuthnot Lane’s disease). Br J Surg. 1984;71(7):547–52.PubMedCrossRefPubMedCentralGoogle Scholar
  83. 83.
    Knowles CH, Scott M, Lunniss PJ. Outcome of colectomy for slow transit constipation. Ann Surg. 1999;230(5):627–38.PubMedPubMedCentralCrossRefGoogle Scholar
  84. 84.
    Mollen RM, Kuijpers HC, Claassen AT. Colectomy for slow-transit constipation: preoperative functional evaluation is important but not a guarantee for a successful outcome. Dis Colon Rectum. 2001;44(4):577–80.PubMedCrossRefPubMedCentralGoogle Scholar
  85. 85.
    Gladman MA, Scott SM, Lunniss PJ, et al. Systematic review of surgical options for idiopathic megarectum and megacolon. Ann Surg. 2005;241:562–74.PubMedPubMedCentralCrossRefGoogle Scholar
  86. 86.
    Nicholls RJ, Kamm MA. Proctocolectomy with restorative ileoanal reservoir for severe idiopathic constipation. Report of two cases. Dis Colon Rectum. 1988;31(12):968–9.PubMedCrossRefPubMedCentralGoogle Scholar
  87. 87.
    Hosie KB, Kmiot WA, Keighley MR. Constipation: another indication for restorative proctocolectomy. Br J Surg. 1990;77:801–2.PubMedCrossRefPubMedCentralGoogle Scholar
  88. 88.
    Stewart J, Kumar D, Keighley MR. Results of anal or low rectal anastomosis and pouch construction for megarectum and megacolon. Br J Surg. 1994;81:1051–3.PubMedCrossRefPubMedCentralGoogle Scholar
  89. 89.
    Kalbassi MR, Winter DC, Deasy JM. Quality-of-life assessment of patients after ileal pouch–anal anastomosis for slow-transit constipation with rectal inertia. Dis Colon Rectum. 2003;46:1508–12.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Michael Powar
    • 1
  • Justin Davies
    • 1
  1. 1.Cambridge Colorectal UnitAddenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation TrustCambridgeUK

Personalised recommendations