Ileoanal Anastomosis for Ulcerative Colitis

Surgery Overview

This surgery is done to treat ulcerative colitis. The doctor removes all of the large intestine (colon) and the diseased lining of the rectum. This surgery is also called an ileal pouch-anal anastomosis (IPAA).

In an ileoanal procedure, the lining of the rectum is removed, and the lower end of the small intestine (the ileum) is attached to the opening of the anus. The surgeon makes a pouch from the ileum to hold fecal material (stool). The lower end of the pouch is attached to the anus. The muscles around the rectum are left in place. This allows for fairly normal bowel movements.

The ileoanal procedure cures ulcerative colitis by removing all the tissue that the disease could return to.

What To Expect After Surgery

This surgery is sometimes done in two stages. In the first surgery, the doctor removes the large intestine, makes an opening in the abdomen, and attaches the ileum to the opening. This is called an ileostomy. In a second surgery, the pouch is formed from the ileum and then attached to the opening of the anus. Recovery from each surgery takes 1 to 2 weeks. The two steps may be done in the same operation if you are not ill at the time of surgery.

Why It Is Done

This surgery can be done for most patients who have ulcerative colitis. Several circumstances may require surgery for ulcerative colitis.

This surgery is not done:

• For people whose rectal muscles do not work normally.
• For some people who have colon or rectal cancer.

How Well It Works

Ths surgery is usually successful. About 7 or 8 out of 10 people have no problems after surgery. And most people say their quality of life is better after surgery.¹

Risks

About 25 to 30 out of 100 people who have this surgery have one or more of the following complications:²

• Inflammation of the ileal pouch (pouchitis)
• Blockage of the small intestine (small bowel obstruction)
• Pelvic infection (sepsis)
• Abdominal sepsis
• Major leakage of stool (incontinence)

Less than 10 out of 100 people have sexual problems.²

Women may have a harder time getting pregnant (infertility) after ileoanal anastomosis.³

What To Think About

The ileoanal procedure has become the preferred surgery, because it cures ulcerative colitis and doesn't require the person to have an ostomy in order to have bowel movements.

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

References

Citations

1. Cohen JL, et al. (2005). Practice parameters for the surgical treatment of ulcerative colitis. Diseases of the Colon and Rectum, 48(11): 1997–2009. Available online: http://www.fascrs.org/physicians/practice_parameters.

2. Cima RR, Pemberton JH (2010). Ileostomy, colostomy, and pouches. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed., vol. 2, pp. 2015–2025. Philadelphia: Saunders Elsevier.

3. Waljee A, et al. (2006). Threefold increased risk of infertility: A meta-analysis of infertility after ileal pouch anal anastomosis in ulcerative colitis. Gut, 55(11): 1575–1580.