The J-pouch for Patients with Crohn’s Disease and Indeterminate Colitis: (When) Is it an Option?

Excerpt

When surgery for Crohn’s disease (CD) is indicated, limited segmental resections to preserve bowel length and avoidance of unnecessary or prophylactic resections are the classic mainstays of therapy; total (procto-)colectomy followed by restorative techniques such as ileal pouch-anal anastomosis (IPAA), the procedure of choice after failed medical therapy in ulcerative colitis (UC), is generally believed to have no role in the surgical management of CD. However, patients with severe colonic CD with an absence of small bowel involvement or perianal disease are, by nature and extent of their disease, potential candidates for restorative proctocolectomy; the indications and outcomes of this rather rare indication for pouch surgery is the focus of this review. For CD of the colon with relative sparing of the rectum, total abdominal colectomy and straight ileorectal anastomosis (SIRA) is an option and has been shown to lead to acceptable quality of life (QOL) and good functional outcomes.1 If severe CD involves the rectum as well, total proctocolectomy may become mandatory, which has previously required a permanent ileostomy. For this subset of patients, a number of authors have suggested performing an IPAA in carefully selected patients. …