Restorative proctocolectomy with ileal pouch-anal anastomosis (RP/IPAA) is the procedure of choice for patients with ulcerative colitis and selected patients with familial adenomatous polyposis [1, 2] (Fig. 20.1). J-pouch is the most commonly used reservoir because it is easier to construct compared with S or W pouches  (Fig. 20.2). Stapled IPAA has become the preferred approach with good long-term functional outcomes and quality of life (QOL) over a hand-sewn anastomosis  (Fig. 20.3). In patients with toxic megacolon or severe fulminant colitis, RP/IPAA is performed in multistages including subtotal colectomy and end ileostomy and then in about 6 months completion proctectomy and IPAA with/without diverting ileostomy. Ileostomy is closed in 3 months following IPAA after checking integrity of pouch and IPAA using water-contrasted enema.
KeywordsFamilial Adenomatous Polyposis Restorative Proctocolectomy Pelvic Sepsis Pouch Failure Reoperative Surgery