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Indications for Ileal Pouch Reconstruction

Ileal pouch reconstruction surgery performed by UW Health surgeons patients with conditions such as ulcerative colitis, familial polyposis and certain types of colon cancer to avoid living with a permanent ileostomy and external appliance after colectomy. 
 
Most ileal pouch reconstruction recipients have a history of familial polyposis or ulcerative colitis that has failed to respond to more conservative treatments. Additionally, some have hereditary cancers that require colon removal.
 
Ulcerative Colitis
 
Ulcerative colitis is an inflammatory bowel disease that causes ulceration of the colon (large intestine). Because ulcerative colitis involves only the colon, we can use the lower part of the ileum to create an internal pouch.
 
Unless you have specific health problems prohibiting surgery, you may be a candidate for total abdominal colectomy and ileal pouch reconstruction if you have: 
  • Severe or sudden occurrence of disease that does not respond to medication
  • Chronically active disease that requires long-term treatment with immunosuppressant drugs or steroids
  • Recurrent or persistent flare-ups or disease that compromises your quality of life
  • Secondary complications such as skin disorders (i.e., pyoderma gangrenosum)
  • Evidence of cancer or dysplasia (abnormal cells) 
Familial Polyposis
 
This genetically transmitted disorder, which often begins in adolescence, manifests itself as a large number of polyps in the colon. If untreated, the chance of developing colon cancer is 100 percent, with the majority of cancers occurring by age 40.
 
If you have few or no polyps in the rectal region, one option is to remove the colon and leave the rectum. Patients who have this condition may be candidates for ileo-rectal anastomosis (joining of the ileum and rectum). If you have a significant number of rectal polyps, total colectomy with ileal pouch reconstruction is preferred.
 
Hereditary Non-polyposis Colon Cancer
 
Recent research has identified patients and families who are genetically susceptible to this type of colon cancer. If hereditary non-polyposis colon cancer runs in your family, total abdominal colectomy with ileal pouch reconstruction is an option for decreasing your risk of colon cancer.
 
Factors for Unsuitable Candidates
 
Patients who are not good candidates for total abdominal colectomy and ileal pouch reconstruction include those who: 
  • Have Crohn's disease
  • Are incontinent and have poor sphincter muscle tone
  • Have had previous sphincter injury
  • Have undergone partial removal of the small bowel 
In addition, some patients who are obese or who have heart and/or lung disease may not be candidates.