[Reconstruction of proctocolectomy: which is the best surgical procedure?]

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.