What can be expected after ileal pouch surgery?

In most cases after ileal pouch surgery, quality of life improves over time. Patients can usually resume normal work and activities about 4-8 weeks after surgery. What ulcerative colitis patients like most about having any kind of pouch is that they no longer have the severe urgency or need to run to the bathroom.

After ileal pouch surgery, the patient must have an examination of the inside of the pouch with an instrument called an endoscope every year or every other year for the rest of his or her life to watch for the development of precancerous cells. In addition, all types of pouches can develop pouchitis, an irritation and inflammation of the inner lining of the pouch. Pouchitis is very common, but usually responds to oral antibiotics within 24 hours.

Overall, the long-term success rate of the pouch procedure is approximately 95%. However, there is a 5-10% chance of failure after pouch surgery. Most failures are due to the wrong diagnosis (for example, constructing a pouch in cases of Crohn’s disease), persistent severe pouchitis, or complications of surgery.

In some cases, the pouch may need to be repaired or removed and replaced with a new pouch. Another option is to convert the pouch to a permanent ileostomy (an opening through the abdominal wall to evacuate waste).

People in the following situations or who have these conditions may not be good candidates for ileal pouch surgery:

  • Crohn’s disease: This inflammatory condition of the entire digestive tract has a high risk of returning after treatment. Therefore, it is not a good idea to use the small intestine to construct a pouch. In some cases of pure Crohn’s colitis without small bowel or perianal disease, a pouch may be an option.
  • Anal incontinence: problems controlling rectal functions.
  • Older age: Although a number of elderly patients do well with an ileal pouch, the ideal age range for this surgery is 20-50 years old, when anal sphincter control is at its best.
  • Obesity: People who are morbidly obese are not good candidates because of the greater chance of surgical complications, and a thick abdominal wall that makes the procedure more difficult to perform.

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