Role of surgery in patients with pouchitis

Restorative proctocolectomy with an ileal pouch-anal anastomosis (IPAA) has been an ideal surgical option for patients with chronic ulcerative colitis (UC) and familial adenomatous polyposis for nearly 4 decades. In most cases, patients enjoy excellent quality of life with a durable surgical and functional result, avoiding the need for a lifelong ileostomy.Despite great success, patients with IPAA may suffer from several pouch-related complications that are a challenge for the patient and surgeon. Pouchitis is one such challenging complication that requires thoughtful consideration and judgment for successful management. Treatment of pouchitis has historically revolved around medical therapy, but the surgeon׳s role in a multidisciplinary approach to pouchitis is critical for diagnosis, treatment, and improvement of quality of life.The focus of this review is to provide a structured approach to the challenges that the surgeon encounters when faced with a patient with chronic or refractory pouchitis and to discuss the surgical options that mitigate the morbidity caused by pouchitis in parallel with or when medical treatments fail.