Anastomose iléo-anale : complications à long terme

Coloprotecomy with ileal pouch-anal anastomosis (IAA) has been used for 30 years. This intervention remains the standard technique when surgery is indicated in case of familial adenomatous polyposis or ulcerative colitis. Though the surgical act is sure, with mortality below 1%, the morbidity rate varies between 18 and 70%. We thought a literature review about long-term complications would be enlightening. Pochitis is the most current complication with a 70% rate within 20 years after the intervention. Small bowel occlusion affects 25% of patients. Pelvic sepsis occurs in 20 to 30% of cases within 10 years. IAA impacts patient's sexual life, as may appear ejaculation trouble, dyspareunia or leeks during sexual intercourse. Nevertheless, patients affected with UC describe a significant appreciation of this aspect of their lives after surgery. Failure rate varies from 3.5 to 15%. Major failure causes are sepsis, unknown Crohn disease and poor functional results. Cases of dysplasia and cancer have not only been reported on pouch but above all on glandular mucosa left in place. Supervision of the transitional zone might be recommended in case of risk factor. Coloprotectomy with ileal pouch-anal anastomisis burdened with frequent morbidity which shall not hide patients' satisfaction.