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Ileal Pouch-Anal Anastomosis

  • Author: Michael B Brewer, MD; Chief Editor: Kurt E Roberts, MD  more...
Updated: Dec 03, 2015


The ileal pouch–anal anastomosis (IPAA) is a surgical procedure that is used to restore gastrointestinal continuity after surgical removal of the colon and rectum. Various conditions, including inflammatory states, cancer, or infection, may necessitate the complete surgical removal of the colon and rectum.

Also called a J pouch or an internal pouch, the procedure involves the creation of a pouch of small intestine to recreate the removed rectum. Two or more loops of intestine are sutured or stapled together to form a reservoir for stool. This reservoir is then attached to the anus for reestablishment of anal fecal flow. The IPAA is often protected by temporarily diverting the path of stool through the abdominal wall in the form of an upstream ileostomy. After a period of recovery, this ileostomy is reversed during a separate procedure.



The IPAA procedure is performed after the colon and rectum have been completely removed. Removal of the colon and rectum is termed proctocolectomy. When an IPAA follows, the procedure is called a restorative proctocolectomy. Indications for restorative proctocolectomy include the following[1] :



Creation of a J pouch is contraindicated when the small bowel is involved in the disease process. This is most common when proctocolectomy is performed for Crohn disease, because the distal ileum is often affected. IPAA is also contraindicated when the distal rectum or anal canal is diseased, as with Crohn disease or rectal cancer.


Technical Considerations

Complication prevention

Several standardized practices are followed to decrease the incidence of perioperative complications. Antibiotics are given within 1 hour of surgery to lower the rate of wound infection. Compression devices are placed on the legs to decrease the likelihood of blood clot formation. Patients are typically asked to stop taking any antiplatelet agents (eg, aspirin or clopidogrel) 1 week prior to surgery. This reduces bleeding complications. Finally, before starting surgery, the surgeons, operating room staff, and anesthesia team should verify the correct patient and procedure in order to prevent errors.

Contributor Information and Disclosures

Michael B Brewer, MD Resident Physician in General Surgery, Department of Surgery, University of Maryland Medical Center

Michael B Brewer, MD is a member of the following medical societies: American College of Physicians, American College of Surgeons, American Medical Association, Society for Vascular Surgery

Disclosure: Nothing to disclose.


Andrea C Bafford, MD Assistant Professor, Section of Colon and Rectal Surgery, Division of General and Oncologic Surgery, Department of Surgery, University of Maryland School of Medicine, University of Maryland Medical Center

Andrea C Bafford, MD is a member of the following medical societies: American College of Surgeons, American Society of Colon and Rectal Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Kurt E Roberts, MD Assistant Professor, Section of Surgical Gastroenterology, Department of Surgery, Director, Surgical Endoscopy, Associate Director, Surgical Skills and Simulation Center and Surgical Clerkship, Yale University School of Medicine

Kurt E Roberts, MD is a member of the following medical societies: American College of Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons

Disclosure: Nothing to disclose.

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Ileal pouch-anal anastomosis.
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