Ileoanal anastomosis for ulcerative colitis

Surgery Overview

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This surgery is done to treat ulcerative colitis. The doctor removes all of the large intestine (colon) and the diseased lining of the rectum.

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, allowing fairly normal bowel movements.

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

What To Expect After Surgery

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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 and 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

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Several circumstances may require surgery for ulcerative colitis.

Ileoanal surgery is preferred for younger people who have an increased risk of cancer or who have ulcerative colitis that does not respond to medicines.

This surgery is not done:

• To treat Crohn's disease.
• For people whose rectal muscles do not work normally.
• For people who have precancerous changes in the rectum or who have cancer in the rectum.
• For some people older than age 65.

How Well It Works

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Most people report moderately high satisfaction. After ileoanal surgery, most people can have almost normal bowel movements.¹

• You may have an average of 2 to 8 partially formed stools a day.
• Many people have some minor leaking of stool at night, and a few have it during the day. It may be necessary to wear a pad at night to protect bedding.

Risks

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About 25% to 30% of people overall 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)
• Sexual difficulties

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

What To Think About

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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.

After ileoanal surgery, children and young adults usually become used to having bowel movements more often than usual.

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

References

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Citations

1. Change GJ, et al. (2006). Colitis section of Large intestine. In GM Doherty, LW Way, eds., Current Surgical Diagnosis and Treatment, 12th ed., pp. 722–729. New York: McGraw-Hill.

2. Cima RR, Pemberton JH (2006). Ileostomy, colostomy, and pouches. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 2, pp. 2549–2561. 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.

Credits

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Author	Monica Rhodes
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Arvydas D. Vanagunas, MD - Gastroenterology
Last Updated	November 3, 2008