Ileo-anal Pouch

Ileo-anal pouch is a surgical procedure performed in a patient who has had his entire colon surgically removed including the rectum. The creation of the pouch aims to ensure the high quality of life and maintain the most natural defecation. Therefore, it can be understood as a slightly improved variant of ileostomy.

Indications

As mentioned above, the pouch is created after surgical removal of the colon to the rectum, which could be performed in certain forms of Crohn's disease, in ulcerative colitis, familial adenomatous polyposis (and similar congenital diseases) and colorectal cancer.

Principle

The principle is connection of the terminal part of the small intestine to the preserved remaining part of rectum with anal sphincter. In addition, the terminal loops of the small intestine are stacked side by side and stapled to each other, thus forming a kind of extended bag that takes over the function of the original rectum.

 

The operation is usually carried out in several steps. First part includes the removal of the colon and rectum, creation of the ileo-anal pouch and creating a temporary ileostomy, i.e. opening of the small intestine on the abdominal surface. This step allows the intestine to heal and get prepared for the second stage. The second stage is performed after 2-3 months. The ileostomy is removed and the small intestine is connected with the pouch. Temporary ileostomy diverts the stool from the newly created pouch, which should prevent its infection.

 

Ileoanal pouch
Created ileo-anal pouch

 

Disadvantages

The pouch can not fully replace the function of the original rectum. After the operation, the patient suffers from nausea, local pain and frequent diarrhea. This condition gradually improves, but the necessity to defecate more times a day usually lasts.

 

Pouchitis is another unpleasant complication. This inflammation of the pouch is typical in pouches created in patients with ulcerative colitis. The inflammation is treated by anti-inflammatory drugs, antibiotics and probiotics. When the situation can not be handled conservatively, the pouch must be surgically removed.

Advantages

The main advantage is a relatively good imitation of rectal function. The only alternative is the creation of a permanent ileostomy, i.e. opening of the small intestine on the abdominal surface. In this case, however, the stool continuously constantly slowly flows out of the body and it must be collected in a special bag that is stuck to the skin around the newly created opening.