Total proctocolectomy is commonly performed in patients with
ulcerative colitis or familial adenomatosis coli. The standard
surgical procedure for reconstruction is the
ileal pouch anal anastomosis with rectal mucosal stripping (IPAA), which is radical treatment for the disease, or stapled
ileal pouch anal anastomosis with preserved anal canal (stapled IPAA), which results in a lower incidence of soiling with a high possibility of one-stage surgery. Postoperative
cancer surveillance colonoscopy is recommended in patients with stapled IPAA, and patients with IPAA have also at risk for
cancer in the anastomotic site, although at very low incidence. Quality of life (QOL) studies (SF36, etc.) found good QOL after surgery in patients who underwent both procedures. Patients with permanent
ileostomy for preoperative anal dysfunction also had good QOL. The
surgical procedure for reconstruction should be determined based on surgical indications, preoperative anal function, and patient's request. For improved QOL in the future, pouch surgery should have a lower incidence of diverting
ileostomy and result in fewer bowel movements and a lower incidence of soiling, with optimal management of
pouchitis.