Ileo-anal Pouch - Surgical Procedure

Surgical Procedure

The entire procedure can be performed in one operation, but is usually split into two or three. When done as a two-step, the first operation (step one) involves a proctocolectomy (removal of the large intestine and rectum), and fashioning of the pouch. The patient is given a temporary defunctioning ileostomy (also known as a "loop ileostomy"). After a period of usually 6-12 weeks the second step (sometimes called the "takedown") is performed, in which the ileostomy is reversed. The reason for the temporary ileostomy is to allow the newly constructed pouch to fully heal without waste passing through it, thus avoiding infection.

Some surgeons prefer to perform a subtotal colectomy (removing all the colon except the rectum), since removal of the rectum can lead to complications with the anal sphincters. When a colectomy is performed as an emergency (which can arise from toxic megacolon and other complications), or when the patient is extremely ill, the colectomy and pouch construction are performed in separate stages, resulting in a three-part surgery.