The Augmentation Pouch: Adding an S Pouch to a Straight Ileal-Anal Anastomosis.

BACKGROUND

Straight ileo-anal anastomosis in patients undergoing proctocolectomy for ulcerative colitis or familial adenomatous polyposis is associated with diarrhea, incontinence, and anal excoriation. Techniques to improve function include takedown of the ileo-anal anastomosis with construction of a pouch and redo ileal pouch-anal anastomosis, or multiple ileal myotomies. Here is a technique for augmenting the ileum without taking down the ileo-anal anastomosis.

IMPACT OF INNOVATION: Improves function in patients with straight ileo-anal anastomosis.

MATERIALS AND

METHODS

The apex of redundancy in the loop of distal ileum is pulled down toward the pelvis alongside the ileum going down to the anastomosis, and an S pouch is created. The apex of the loop is placed as close to the existing ileo-anal anastomosis as possible. A diverting ileostomy is constructed.

PRELIMINARY

RESULTS

Four male patients with familial polyposis underwent this procedure. All recovered without complication, retained their S pouch, and noted improved function. One patient seen after formation and immediate excision of a J pouch underwent straight ileo-anal anastomosis with immediate construction of an augmentation S. There were no complications. Function is acceptable.

CONCLUSIONS AND FUTURE DIRECTIONS: Augmenting the terminal ileum above a straight ileo-anal anastomosis without disturbing the anastomosis is possible and may allow the patients to avoid a permanent ileostomy.