Ulcerative Colitis: Surgical Management

  • Zuri Murrell
  • Phillip Fleshner


Ulcerative colitis (UC) is a diffuse inflammatory disease of the mucosal lining of the colon and rectum that manifests clinically as diarrhea, abdominal pain, fever, weight loss, and rectal bleeding. Since removal of the affected organ is curative, surgery has assumed a pivotal position in the management of these patients. Although removal of the entire colon and rectum with a permanent ileostomy had been the standard operation for decades, increased experience with anal sphincter preservation has demonstrated the feasibility of performing surgical procedures which spare sphincter function while still removing all disease. This chapter considers the surgical alternatives, decision making, and techniques surrounding these procedures.


  1. 1.
    Lichtiger S, Present DH, Kornbluth A, et al. Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med. 1994;330:1841–5.PubMedGoogle Scholar
  2. 2.
    Rutgeerts P, Sandborn WJ, Feagan BG, et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2005;353:2462–76.PubMedGoogle Scholar
  3. 3.
    Fleshner PR, Michelassi F, Rubin M, et al. Morbidity of subtotal colectomy in patients with severe ulcerative colitis unresponsive to cyclosporin. Dis Colon Rectum. 1995;38:1241–5.PubMedGoogle Scholar
  4. 4.
    Hyde GM, Jewell DP, Kettlewell MGW, et al. Cyclosporin for severe ulcerative colitis does not increase the rate of perioperative complications. Dis Colon Rectum. 2001;44:1436–40.PubMedGoogle Scholar
  5. 5.
    Schluender SJ, Ippoliti A, Dubinsky M, et al. Does infliximab influence surgical morbidity of ileal pouch-anal anastomosis in patients with ulcerative colitis? Dis Colon Rectum. 2007;50:1747–53.PubMedGoogle Scholar
  6. 6.
    Selvasekar CR, Cima RR, Larson DW, et al. Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis. J Am Coll Surg. 2007;204:956–63.PubMedGoogle Scholar
  7. 7.
    Eaden JA, Abrams KR, Mayberry JF. The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut. 2001;48:526–35.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Goldblum JR. The histologic diagnosis of dysplasia, dysplasia-associated lesion or mass, and adenoma: a pathologist’s perspective. J Clin Gastroenterol. 2003;36(Suppl):S6–69.Google Scholar
  9. 9.
    Motil KJ, Grand RJ, Davis-Kraft L, et al. Growth failure in children with inflammatory bowel disease: a prospective study. Gastroenterology. 1993;105:681–91.PubMedGoogle Scholar
  10. 10.
    Camilleri-Brennan J, Steele RJ. Objective assessment of quality of life following panproctocolectomy and ileostomy for ulcerative colitis. Ann R Coll Surg Engl. 2001;83(5):321–4.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Nessar G, Fazio VW, Tekkis P, et al. Long-term outcome and quality of life after continent ileostomy. Dis Colon Rectum. 2006;49:336–44.PubMedGoogle Scholar
  12. 12.
    Fazio VW, Church JM. Complications and function of the continent ileostomy at the Cleveland Clinic. World J Surg. 1988;12:148–54.PubMedGoogle Scholar
  13. 13.
    Lian L, Fazio VW, Remzi FH, Shen B, Dietz D, Kiran RP. Outcomes for patients undergoing continent ileostomy after a failed ileal pouch-anal anastomosis. Dis Colon Rectum. 2009;52:1409–16.PubMedGoogle Scholar
  14. 14.
    Mortier PE, Gambiez L, Karoui M, et al. Colectomy with ileorectal anastomosis preserves female fertility in ulcerative colitis. Gastroentérol Clin Biol. 2006;30:594–7.PubMedGoogle Scholar
  15. 15.
    Holubar SD, Larson DW, Dozois EJ, Pattana-arun J, Pemberton JH, Cima RR. Minimally invasive subtotal colectomy and ileal pouch-anal anastomosis for fulminant ulcerative colitis: a reasonable approach? Dis Colon Rectum. 2009;52:187–92.PubMedGoogle Scholar
  16. 16.
    Heuschen UA, Hinz U, Allemeyer EH, et al. Risk factors for ileoanal J pouch-related septic complications in ulcerative colitis and familial adenomatous polyposis. Ann Surg. 2002;235(2):207–16.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Alves A, Panis Y, Bouhnik Y, et al. Subtotal colectomy for severe acute colitis: a 20-year experience of a tertiary care center with an aggressive and early surgical policy. J Am Coll Surg. 2003;197:379–85.PubMedGoogle Scholar
  18. 18.
    Holubar SD, Privitera A, Cima RR, Dozois EJ, Pemberton JH, Larson DW. Minimally invasive total proctocolectomy with Brooke ileostomy for ulcerative colitis. Inflamm Bowel Dis. 2009;15:1337–42.PubMedGoogle Scholar
  19. 19.
    Brooke BN. The management of an ileostomy, including its complications. Lancet. 1952;2:102–4.PubMedGoogle Scholar
  20. 20.
    Frizelle A, Pemberton JH. Removal of the anus during proctectomy. Br J Surg. 1997;84:68–72.PubMedGoogle Scholar
  21. 21.
    Wickland M, Jansson I, Asztely M, et al. Gynaecological problems related to anatomical changes after conventional proctocolectomy and ileostomy. Int J Colorectal Dis. 1990;5:49–52.Google Scholar
  22. 22.
    Carlsen E, Bergan A. Technical aspects and complications of end ileostomies. World J Surg. 1995;19:632–6.PubMedGoogle Scholar
  23. 23.
    Kock NG, Darle N, Kewenter J, et al. Ileostomy. Curr Probl Surg. 1977;14:1–52.PubMedGoogle Scholar
  24. 24.
    Litle VR, Barbour S, Schrock TR, Welton ML. The continent ileostomy: long-term durability and patient satisfaction. J Gastrointest Surg. 1999;3:625–32.PubMedGoogle Scholar
  25. 25.
    Lepisto AH, Jarvinen HJ. Durability of Kock continent ileostomy. Dis Colon Rectum. 2003;46(7):925–8.PubMedGoogle Scholar
  26. 26.
    Beck DE. Clinical aspects of continent ileostomies. Clin Colon Rectal Surg. 2004;17:57–63.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Mullen P, Behrens D, Chalmers T, et al. Barnett continent intestinal reservoir. Multicenter experience with an alternative to the Brooke ileostomy. Dis Colon Rectum. 1995;38(6):573–82.PubMedGoogle Scholar
  28. 28.
    Leijonmarck CE, Lofberg R, Hellers G. Long-term results of ileorectal anastomosis in ulcerative colitis in Stockholm County. Dis Colon Rectum. 1990;33:195–200.PubMedGoogle Scholar
  29. 29.
    Newton CR, Baker WNW. Comparison of bowel function after ileorectal anastomosis for ulcerative colitis and colonic polyposis. Gut. 1975;16:785–91.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Baker WNW, Glass RE, Richie JK, et al. Cancer of the rectum following colectomy and ileorectal anastomosis for ulcerative colitis. Br J Surg. 1978;65:862–8.PubMedGoogle Scholar
  31. 31.
    Soravia C, O’Connor BI, Berk T, et al. Functional outcome of conversion of ileorectal anastomosis to ileal pouch-anal anastomosis in patients with familial adenomatous polyposis and ulcerative colitis. Dis Colon Rectum. 1999;42:903–8.PubMedGoogle Scholar
  32. 32.
    Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. BMJ. 1978;2:85–8.PubMedGoogle Scholar
  33. 33.
    Johnston D, Holdsworth PJ, Nasmyth DG, et al. Preservation of the entire anal canal in conservative proctocolectomy for ulcerative colitis: a pilot study comparing end-to-end ileo-anal anastomosis without mucosal resection with mucosal proctectomy and endo-anal anastomosis. Br J Surg. 1987;74:940–4.PubMedGoogle Scholar
  34. 34.
    Wexner SD, James K, Jagelman DG. The double-stapled ileal reservoir and ileoanal anastomosis: a prospective review of sphincter function and clinical outcome. Dis Colon Rectum. 1991;34:487–94.PubMedGoogle Scholar
  35. 35.
    Rivadeneira DE, Marcello PW, Roberts PL, Rusin LC, Murray JJ, Coller JA, et al. Benefits of hand-assisted laparoscopic restorative proctocolectomy: a comparative study. Dis Colon Rectum. 2004;47:1371–6.PubMedGoogle Scholar
  36. 36.
    Maartense S, Dunker MS, Slors JF, et al. Hand-assisted laparoscopic versus open restorative proctocolectomy with ileal pouch anal anastomosis: a randomized trial. Ann Surg. 2004;240:984–91.PubMedPubMedCentralGoogle Scholar
  37. 37.
    Ambroze Jr WL, Wolff BG, Kelly KA, et al. Let sleeping dogs lie: role of the omentum in the ileal pouch-anal anastomosis procedure. Dis Colon Rectum. 1991;34:563–5.PubMedGoogle Scholar
  38. 38.
    Salum MR, Wexner S, Nogueras JJ, et al. Does sodium hyaluronate and carboxymethylcellulose based bioresorbable membrane (Seprafilm) decrease operative time for loop ileostomy closure? Tech Coloproctol. 2006;10:187–91.PubMedGoogle Scholar
  39. 39.
    Michelassi F, Lee J, Rubin M, et al. Long-term functional results after ileal pouch anal restorative proctocolectomy for ulcerative colitis: a prospective observational study. Ann Surg. 2003;238:433–41.PubMedPubMedCentralGoogle Scholar
  40. 40.
    MacLean AR, Cohen Z, MacRae HM, et al. Risk of small bowel obstruction after the ileal pouch-anal anastomosis. Ann Surg. 2002;235:200–6.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Fazio VW, Cohen Z, Fleshman JW, et al. Reduction in adhesive small-bowel obstruction by Seprafilm adhesion barrier after intestinal resection. Dis Colon Rectum. 2006;49:1–11.PubMedGoogle Scholar
  42. 42.
    Heuschen UA, Allemeyer EH, Hinz U, et al. Outcome after septic complications in J pouch procedures. Br J Surg. 2002;89:194–200.PubMedGoogle Scholar
  43. 43.
    Marcello PW, Roberts PL, Schoëtz Jr DJ, et al. Long-term results of the ileoanal pouch procedure. Arch Surg. 1993;128:500–3.PubMedGoogle Scholar
  44. 44.
    Lewis WG, Kuzu A, Sagar PM, et al. Stricture at the pouch-anal anastomosis after restorative proctocolectomy. Dis Colon Rectum. 1994;35:120–5.Google Scholar
  45. 45.
    Senapati A, Tibbs CJ, Ritchie JK, et al. Stenosis of the pouch anal anastomosis following restorative proctocolectomy. Int J Colorectal Dis. 1996;11:57–9.PubMedGoogle Scholar
  46. 46.
    Prudhomme M, Dozois RR, Godlewski G, et al. Anal canal strictures after ileal pouch-anal anastomosis. Dis Colon Rectum. 2003;46:20–3.PubMedGoogle Scholar
  47. 47.
    Galandiuk S, Scott NA, Dozois RR, et al. Ileal pouch-anal anastomosis. Reoperation for pouch-related complications. Ann Surg. 1990;212:446–52.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Fazio VW, Tjandra JJ. Pouch advancement and neoileoanal anastomosis for anastomotic stricture and anovaginal fistula complicating restorative proctocolectomy. Br J Surg. 1992;79:694–6.PubMedGoogle Scholar
  49. 49.
    Fleshman J, McLeod RS, Cohen Z, Stern H. Improved results following use of an advancement technique in the treatment of ileoanal anastomotic complications. Int J Colorectal Dis. 1988;3:161–5.PubMedGoogle Scholar
  50. 50.
    Wexner SD, Rothenberger DA, Jensen L, et al. Ileal pouch vaginal fistulas: incidence, etiology, and management. Dis Colon Rectum. 1989;32:460–5.PubMedGoogle Scholar
  51. 51.
    Groom JS, Nicholls RJ, Hawley PR, et al. Pouch-vaginal fistula. Br J Surg. 1993;80:936–40.PubMedGoogle Scholar
  52. 52.
    Keighley MR, Grobler SP. Fistula complicating restorative proctocolectomy. Br J Surg. 1993;80:1065–7.PubMedGoogle Scholar
  53. 53.
    Ozuner G, Hull T, Lee P, et al. What happens to a pelvic pouch when a fistula develops? Dis Colon Rectum. 1997;40:543–7.PubMedGoogle Scholar
  54. 54.
    Lee PY, Fazio VW, Church JM, et al. Vaginal fistula following restorative proctocolectomy. Dis Colon Rectum. 1997;40:752–9.PubMedGoogle Scholar
  55. 55.
    Paye F, Penna C, Chiche L, et al. Pouch-related fistula following restorative proctocolectomy. Br J Surg. 1996;83:1574–7.PubMedGoogle Scholar
  56. 56.
    Colombel JF, Ricart E, Loftus Jr EV, et al. Management of Crohn’s disease of the ileoanal pouch with infliximab. Am J Gastroenterol. 2003;98:2239–44.PubMedGoogle Scholar
  57. 57.
    Cohen Z, Smith D, McLeod R. Reconstructive surgery for pelvic pouches. World J Surg. 1998;22:342–6.PubMedGoogle Scholar
  58. 58.
    Wilkinson ZR, Nicholls RJ KH. Ileal pouch-vaginal fistula treated by abdominoanal advancement of the ileal pouch. Br J Surg. 2003;90:1434–5.PubMedGoogle Scholar
  59. 59.
    Burke D, van Laarhoven CJ, Herbst F, et al. Transvaginal repair of pouch-vaginal fistula. Br J Surg. 2001;88:241–5.PubMedGoogle Scholar
  60. 60.
    Wexner SD, Ruiz DE, Genua J, Nogueras JJ, Weiss EG, Zmora O. Gracilis muscle interposition for the treatment of rectourethral, rectovaginal, and pouch-vaginal fistulas: results in 53 patients. Ann Surg. 2008;248:39–43.PubMedGoogle Scholar
  61. 61.
    Lohmuller JL, Pemberton JH, Dozois RR, et al. Pouchitis and extraintestinal manifestations of inflammatory bowel disease after ileal pouch-anal anastomosis. Ann Surg. 1990;211:622–7.PubMedPubMedCentralGoogle Scholar
  62. 62.
    Fazio VW, Ziv Y, Church JM, et al. Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg. 1995;222:120–7.PubMedPubMedCentralGoogle Scholar
  63. 63.
    Meagher AP, Farouk R, Dozois RR, et al. J ileal pouch-anal anastomosis for chronic ulcerative colitis: complications and long-term outcome in 1310 patients. Br J Surg. 1998;85:800–3.PubMedGoogle Scholar
  64. 64.
    Mahadevan U, Sandborn WJ. Diagnosis and management of pouchitis. Gastroenterology. 2003;124:1636–50.PubMedGoogle Scholar
  65. 65.
    Fleshner PR, Ippoliti A, Dubinsky MC, et al. A prospective multivariate analysis of perioperative clinical factors associated with acute or chronic pouchitis after ileal pouch-anal anastomosis. Clin Gastroenterol Hepatol. 2007;5:952–8.PubMedGoogle Scholar
  66. 66.
    Sandborn W, LaRusso N, Schleck C, et al. Pouchitis after ileal pouch-anal anastomosis for ulcerative colitis occurs with increased frequency in patients with associated primary sclerosing cholangitis. Gut. 1996;38:234–9.PubMedPubMedCentralGoogle Scholar
  67. 67.
    Fleshner PR, Vasiliauskas EA, Kam LY, et al. High level perinuclear antineutrophil cytoplasmic antibody (pANCA) in ulcerative colitis patients before colectomy predicts the development of chronic pouchitis after ileal pouch-anal anastomosis. Gut. 2001;49:671–7.PubMedPubMedCentralGoogle Scholar
  68. 68.
    Fleshner PR, Vasiliauskas EA, Dubinsky M, et al. Both preoperative pANCA and anti-CBir1 expression in ulcerative colitis patients influence pouchitis development after ileal pouch-anal anastomosis. Clin Gastroenterol Hepatol. 2008;6:561–8.PubMedPubMedCentralGoogle Scholar
  69. 69.
    Madden MV, McIntyre AS, Nicholls RJ. Double-blind crossover trial of metronidazole versus placebo in chronic unremitting pouchitis. Dig Dis Sci. 1994;39:1193–6.PubMedGoogle Scholar
  70. 70.
    Shen B, Achkar JP, Lashner BA, et al. A randomized trial of ciprofloxacin and metronidazole in treating acute pouchitis. Inflamm Bowel Dis. 2001;7:301–5.PubMedGoogle Scholar
  71. 71.
    Gionchetti P, Rizzello F, Venturi A, et al. Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a doubleblind, placebo-controlled trial. Gastroenterology. 2000;119:305–9.PubMedGoogle Scholar
  72. 72.
    Holubar S, Hyman N. Continence alterations after ileal pouch-anal anastomosis do not diminish quality of life. Dis Colon Rectum. 2003;46:1489–91.PubMedGoogle Scholar
  73. 73.
    Köhler LW, Pemberton JH, Zinsmeister AR, et al. Quality of life after proctocolectomy. A comparison of Brooke ileostomy, Kock pouch, and ileal pouch-anal anastomosis. Gastroenterology. 1991;101:679–84.PubMedGoogle Scholar
  74. 74.
    Olsen KO, Joelsson M, Laurberg S, et al. Fertility after ileal pouch-anal anastamosis in women with ulcerative colitis. Br J Surg. 1999;86:493–5.PubMedGoogle Scholar
  75. 75.
    Olsen KO, Juul S, Berndtsson I, et al. Ulcerative colitis: female fecundity before diagnosis, during disease, and after surgery compared with a population sample. Gastroenterology. 2002;122:15–9.Google Scholar
  76. 76.
    Cornish JA, Tan E, Teare J, et al. The effect of restorative proctocolectomy on sexual function, urinary function, fertility, pregnancy and delivery: a systematic review. Dis Colon Rectum. 2007;50:1128–38.PubMedGoogle Scholar
  77. 77.
    Oresland T, Palmblad S, Ellstrom M, et al. Gynaecological and sexual function related to anatomical changes in the female pelvis after restorative proctocolectomy. Int J Colorectal Dis. 1994;9:77–81.PubMedGoogle Scholar
  78. 78.
    Indar AA, Efron JE, Young-Fadok TM. Laparoscopic ileal pouch-anal anastomosis reduces abdominal and pelvic adhesions. Surg Endosc. 2009;23:174–7.PubMedGoogle Scholar
  79. 79.
    Remzi FH, Gorgun E, Bast J, et al. Vaginal delivery after ileal pouch-anal anastomosis: a word of caution. Dis Colon Rectum. 2005;48:1691–9.PubMedGoogle Scholar
  80. 80.
    Ravid A, Richard CS, Spencer LM, et al. Pregnancy, delivery, and pouch function after ileal pouch-anal anastomosis for ulcerative colitis. Dis Colon Rectum. 2003;45:1283–8.Google Scholar
  81. 81.
    Sultan AH, Kamm MA, Hudson CN, et al. Anal-sphincter disruption during vaginal delivery. N Engl J Med. 1993;329:1905–11.PubMedGoogle Scholar
  82. 82.
    Snooks SJ, Setchell M, Swash M, et al. Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet. 1984;2:546–50.PubMedGoogle Scholar
  83. 83.
    Price AB. Overlap in the spectrum of non-specific inflammatory bowel disease – “colitis indeterminate”. J Clin Pathol. 1978;31:567–77.PubMedPubMedCentralGoogle Scholar
  84. 84.
    Marcello PW, Schoetz Jr DJ, Roberts PL, et al. Evolutionary changes in the pathologic diagnosis after the ileoanal pouch procedure. Dis Colon Rectum. 1997;40:263–9.PubMedGoogle Scholar
  85. 85.
    Yu CS, Pemberton JH, Larson D. Ileal pouch-anal anastomosis in patients with indeterminate colitis. Long-term results. Dis Colon Rectum. 2000;43:1487–96.PubMedGoogle Scholar
  86. 86.
    Dayton MT, Larsen KR, Christiansen DD. Similar functional results and complications after ileal pouch-anal anastomosis in patients with indeterminate colitis vs ulcerative colitis. Arch Surg. 2002;137:690–5.PubMedGoogle Scholar
  87. 87.
    Murrell ZA, Melmed GY, Ippoliti A, et al. A prospective evaluation of the long-term outcome of ileal pouch-anal anastomosis in patients with inflammatory bowel disease-unclassified and indeterminate colitis. Dis Colon Rectum. 2009;52:872–8.PubMedGoogle Scholar
  88. 88.
    Silverberg MS, Satsangi J, Ahmad T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease. Report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005;19(Suppl A):5–36.Google Scholar
  89. 89.
    Takao Y, Gilliland R, Nogueras JJ, et al. Is age relevant to functional outcome after restorative proctocolectomy for ulcerative colitis? Prospective assessment of 122 cases. Ann Surg. 1998;227:187–94.PubMedPubMedCentralGoogle Scholar
  90. 90.
    Chapman JR, Larson DW, DW WBG, et al. Ileal pouch-anal anastomosis: does age at the time of surgery affect outcome? Arch Surg. 2005;140:534–40.PubMedGoogle Scholar
  91. 91.
    McIntyre PB, Pemberton JH, Wolff BG, et al. Comparing functional results one year and ten years after ileal pouch-anal anastomosis for chronic ulcerative colitis. Dis Colon Rectum. 1994;37:303–7.PubMedGoogle Scholar
  92. 92.
    Bullard KM, Madoff RD, Gemlo BT. Is ileoanal pouch function stable with time? Dis Colon Rectum. 2002;45:299–304.PubMedGoogle Scholar
  93. 93.
    Taylor BA, Wolff BG, Dozois RR. Ileal pouch-anal anastomosis for chronic ulcerative colitis and familial polyposis coli complicated by adenocarcinoma. Dis Colon Rectum. 1988;31:358–62.PubMedGoogle Scholar
  94. 94.
    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
  95. 95.
    Wiltz O, Hashmi HF, Schoetz Jr DJ, et al. Carcinoma and the ileal pouch-anal anastomosis. Dis Colon Rectum. 1991;34:805–9.PubMedGoogle Scholar
  96. 96.
    Becker JM, Lamonte WS, Marie G, et al. Extent of smooth muscle resection during mucosectomy and ileal pouch anal anastomosis affects anorectal physiology and functional outcome. Dis Colon Rectum. 1997;40:653–60.PubMedGoogle Scholar
  97. 97.
    Branco BC, Sachar DB, Heimann TM, Sarpel U, Harpaz N, Greenstein AJ. Adenocarcinoma following ileal pouch-anal anastomosis for ulcerative colitis: review of 26 cases. Inflamm Bowel Dis. 2009;15:295–9.PubMedGoogle Scholar
  98. 98.
    Thompson-Fawcett MW, Warren BF. “Cuffitis” and inflammatory changes in the columnar cuff, anal transitional zone, and ileal reservoir after stapled pouch-anal anastomosis. Dis Colon Rectum. 1999;42:348–55.PubMedGoogle Scholar
  99. 99.
    Shen B, Lashner BA, Bennett AE. Treatment of rectal cuff inflammation (cuffitis) in patients with ulcerative colitis following restorative proctocolectomy and ileal pouch-anal anastomosis. Am J Gastroenterol. 2004;99:1527–31.PubMedGoogle Scholar
  100. 100.
    Seow-Choen A, Tsunoda A, Nicholls RJ. Prospective randomized trial comparing anal function after handsewn ileoanal anastomosis versus stapled ileoanal anastomosis without mucosectomy in restorative proctocolectomy. Br J Surg. 1991;78:430–4.Google Scholar
  101. 101.
    Luukkonen P, Jarvinen H. Stapled versus hand sutured ileoanal anastomosis in restorative proctocolectomy: a prospective randomized trial. Arch Surg. 1993;128:437–40.PubMedGoogle Scholar
  102. 102.
    Reilly WT, Pemberton JH, Wolff BG, et al. Randomized prospective trial comparing ileal pouch-anal anastomosis performed by excising the anal mucosa to ileal pouch-anal anastomosis. Ann Surg. 1997;225:666–76.PubMedPubMedCentralGoogle Scholar
  103. 103.
    Schluender S, Mei L, Yang H, Fleshner P. Can a meta-analysis answer the question: is mucosectomy with handsewn or double-stapled anastomosis better in ileal pouch-anal anastomosis? Am Surg. 2006;72:912–6.PubMedGoogle Scholar
  104. 104.
    Remzi FH, Fazio VW, Delaney CP, et al. Dysplasia of the anal transitional zone after ileal pouch-anal anastomosis: results of prospective evaluation after a minimum of ten years. Dis Colon Rectum. 2003;46:6–13.PubMedGoogle Scholar
  105. 105.
    Fonkalsrud EW. Total colectomy and endorectal ileal pull-through with internal ileal reservoir for ulcerative colitis. Surg Gynecol Obstet. 1980;150:1–8.PubMedGoogle Scholar
  106. 106.
    Utsunomiya J, Iwama T, Imago M, et al. Total colectomy, mucosal proctectomy and ileoanal anastomosis. Dis Colon Rectum. 1980;23:459–66.PubMedGoogle Scholar
  107. 107.
    Nicholls RJ, Lubowski DZ. Restorative proctocolectomy: the four loop (W) reservoir. Br J Surg. 1987;74:546–66.Google Scholar
  108. 108.
    Rothenberger DA, Buls JG, Nivatvongs S, et al. The Parks S ileal pouch and anal anastomosis after colectomy and mucosal proctectomy. Am J Surg. 1985;149:390–4.PubMedGoogle Scholar
  109. 109.
    Stone MM, Lewin K, Fonkalsrud EW. Late obstruction of the lateral ileal reservoir after colectomy and endorectal ileal pullthrough procedures. Surg Gynecol Obstet. 1986;162:411–7.PubMedGoogle Scholar
  110. 110.
    Keighley MRB, Yoshioka K, Kmiot W. Prospective randomized trial to compare the stapled double lumen pouch and the sutured quadruple pouch for restorative proctocolectomy. Br J Surg. 1998;75:1008–11.Google Scholar
  111. 111.
    Johnston D, Williamson MER, Lewis WG, et al. Prospective controlled trial of duplicated (J) versus quadrupled (W) pelvic ileal reservoirs in restorative proctocolectomy for ulcerative colitis. Gut. 1996;39:242–7.PubMedPubMedCentralGoogle Scholar
  112. 112.
    Fazio VW, Tjandra JJ, Lavery IC. Techniques of pouch construction. In: Nicholls RJ, editor. Restorative proctocolectomy. Cambridge, MA: Blackwell Scientific; 1993.Google Scholar
  113. 113.
    Galandiuk S, Wolff BG, Dozois RR, et al. Ileal pouch-anal anstomosis without ileostomy. Dis Colon Rectum. 1991;34:870–3.PubMedGoogle Scholar
  114. 114.
    Tjandra JJ, Fazio VW, Milsom JW, et al. Omission of temporary diversion in restorative proctocolectomy – is it safe? Dis Colon Rectum. 1993;36:1007–14.PubMedGoogle Scholar
  115. 115.
    Gorfine SR, Gelernt IM, Bauer JJ, Harris MT, Kreel I. Restorative proctocolectomy without diverting ileostomy. Dis Colon Rectum. 1995;38:188–94.PubMedGoogle Scholar
  116. 116.
    Mowschenson PM, Critchlow JF, Peppercorn MA. Ileoanal pouch operation: long-term outcome with or without diverting ileostomy. Arch Surg. 2000;135:463–5.PubMedGoogle Scholar
  117. 117.
    Fonkalsrud EW, Thakur A, Roof L. Comparison of loop versus end ileostomy for fecal diversion after restorative proctocolectomy for ulcerative colitis. J Am Coll Surg. 2000;190:418–22.PubMedGoogle Scholar
  118. 118.
    Ogunbiyi OA, Korsgen S, Keighley MR. Pouch salvage. Long-term outcome. Dis Colon Rectum. 1997;40:548–52.PubMedGoogle Scholar
  119. 119.
    Fazio VW, Wu JS, Lavery IC. Repeat ileal pouch-anal anastomosis to salvage septic complications of pelvic pouches: clinical outcome and quality of life assessment. Ann Surg. 1998;228:588–97.PubMedPubMedCentralGoogle Scholar
  120. 120.
    MacLean AR, O’Connor B, Parkes R, Cohen Z, McLeod RS. Reconstructive surgery for failed ileal pouch-anal anastomosis: a viable surgical option with acceptable results. Dis Colon Rectum. 2002;45:880–6.PubMedGoogle Scholar
  121. 121.
    Tekkis PP, Heriot AG, Smith JJ, Das P, Canero A, Nicholls RJ. Long-term results of abdominal salvage surgery following restorative proctocolectomy. Br J Surg. 2006;93:231–7.PubMedGoogle Scholar
  122. 122.
    Shawki S, Belizon A, Person B, Weiss E, Sands D, Wexner SD. What are the outcomes of reoperative restorative proctocolectomy and ileal pouch-anal anastomosis surgery? Dis Colon Rectum. 2009;52:884–90.PubMedGoogle Scholar
  123. 123.
    Cohen JL, Strong SA, Hyman NH, et al. Practice parameters for the surgical treatment of ulcerative colitis. Dis Colon ­Rectum. 2005;48:1997–2009.PubMedGoogle Scholar

Copyright information

© ASCRS (American Society of Colon and Rectal Surgeons) 2011

Authors and Affiliations

  • Zuri Murrell
    • 1
  • Phillip Fleshner
    • 2
    • 3
  1. 1.Division of Colorectal SurgeryCedars-Sinai Medical CenterLos AngelesUSA
  2. 2.Clinical Professor of SurgeryCedars-Sinai Medical CenterLos AngelesUSA
  3. 3.UCLA School of MedicineLos AngelesUSA

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