ileal pouch anal anastomosis


Approximately 8 weeks after the IPAA is completed, anal manometry is repeated to ensure that the anal sphincter muscles have retained full function. The volume of the ileal pouch is also measured. Pending the satisfactory outcome of these tests, the loop ileostomy is then closed using a stapling technique, which has greatly simplified this operation. A transverse elliptical incision is made in the skin around the site of the loop ileostomy. The loop is then dissected free from the subcutaneous tissue and the fascia. The afferent and efferent limbs are divided with a stapling device. A side-to-side functional end-to-end anastomosis is then created between the two limbs with a 75-mm anastomosing stapler. The enterotomy is closed with a 60-mm linear stapler. The anastomosed loops of ileum are then placed back into the peritoneal cavity, and the fascia, subcutaneous tissue, and skin are closed. The standard protocol at this center requires that patients are followed at approximately 1 month, 3 months, 6 months, and 12 months after closure of the loop ileostomy and then are seen at yearly intervals for follow-up. Anorectal manometry is repeated at 1 year. 

Unless subsequent long-term complications such as pouchitis arise, patients generally undergo flexible fiberoptic pouchoscopy with surveillance biopsies of the ileal pouch approximately every 5 years.



Ref: Maingot’s 11th ed

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