Complications of restorative proctocolectomy with ileal pouch-anal anastomosis

Restorative proctocolectomy (RPC) with ileal J-pouch-anal anastomosis (IPAA) has become the procedure of choice for most patients who require colectomy because of ulcerative colitis or familial adenomatous polyposis. RPC with IPAA provides an internal reservoir and intestinal continuity, both of which are expected to improve the quality of life of the patient. In addition to the usual complications of abdomino-pelvic surgery, there are other complications more specific to this procedure: pouchitis, pouch ischemia, fistula, and anastomotic leaks (leading potential to pelvic sepsis or abscess). The clinical presentations of complications vary. Often vague symptoms of pelvic, anal or peri-anal pain, low-grade fever, and urinary symptoms may be present. In the case of pouchitis, the most common presenting symptom is increased bowel movement; this may be accompanied by urgency, incontinence, and nocturnal seepage. Initial treatment often involves antibiotic administration; however, in some cases, surgical management may be warranted.