Ileal Pouch Anal Anastomosis and Crohn's Disease

Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice in ulcerative colitis and the majority of patients with familial adenomatous polyposis. The indication for restorative surgery in Crohn's disease, however, is controversial. When ileal pouch-anal anastomosis is performed in a patient with Crohn's disease, significant morbidities such as peripouch abscess, pouchitis, chronic fistulae, and strictures can develop and lead to pouch failure. However, some reports suggest that ileoanal pouch procedures can successfully treat certain cases of colonic Crohn's disease, mainly patients without perianal and small intestinal diseases. Efforts continue to identify the clinical, histological, and endoscopic features that represent these Crohn's patients who will benefit from restorative surgery.