Surgical treatment of ulcerative colitis: ileorectal vs ileal pouch-anal anastomosis

World J Gastroenterol. 2014 Oct 7;20(37):13211-8. doi: 10.3748/wjg.v20.i37.13211.


Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the current gold standard in the surgical treatment of ulcerative colitis (UC) refractory to medical management. A procedure of significant magnitude carries its own risks including anastomotic failure, pelvic sepsis and a low rate of neoplastic degeneration overtime. Recent studies have shown that total colectomy with ileorectal anastomosis (IRA) has been associated with good long-term functional results in a selected group of UC patients amenable to undergo a strict surveillance for the relatively high risk of cancer in the rectum. This manuscript will review and compare the most recent literature on IRA and IPAA as it pertains to postoperative morbidity and mortality, failure rates, functional outcomes and cancer risk.

Keywords: Ileal pouch-anal anastomosis; Ileorectal anastomosis; Neoplastic degeneration; Retained rectum; Ulcerative colitis.

Publication types

  • Review

MeSH terms

  • Anal Canal / surgery*
  • Colitis, Ulcerative / complications
  • Colitis, Ulcerative / diagnosis
  • Colitis, Ulcerative / mortality
  • Colitis, Ulcerative / surgery*
  • Colonic Pouches* / adverse effects
  • Colorectal Neoplasms / etiology
  • Humans
  • Postoperative Complications / etiology
  • Proctocolectomy, Restorative / adverse effects
  • Proctocolectomy, Restorative / methods*
  • Proctocolectomy, Restorative / mortality
  • Rectum / surgery*
  • Risk Assessment
  • Risk Factors
  • Treatment Outcome