Ileo-anal anastomosis and ileal pouch. Surgical treatment of complications

The percentage of complications that request a reoperation after total colectomy with ileo-anal anastomosis is around 20-40%, varying by casistics. Amongst complications, the most frequent is pouchitis, which needs a reoperation only when medical therapy is not successful in controlling the inflammatory process. Reoperation consists in pouch resection and rebuilding. An excessively long efferent loop may cause an impaired emptying of the pouch, fecal incontinence, transanal prolapse and stenosis of the loop itself. In these cases it is useful to shorten the efferent loop, with or without a reduction of diameter of the pouch. The case of a patient affected by ulcerative pancolitis, who underwent surgery repeatedly, with ileal pouch and ileo-anal anastomosis after total colectomy is reported. Because of a progressive difficulty in evacuating, with no stimulus to defecation and lower abdominal pain, and a preoperative diagnosis of stenosis of the efferent loop, the patient underwent exploratory laparotomy. Intraoperatively, an efferent loop with an «S» aspect was observed. Thus, an anastomosis with circular stapler between the efferent loop and the descending part of the pouch was confectioned by transanal route. The patient was discharged with complete remission of symptoms.