Management of J-pouch Complications

Most patients with a restorative proctocolectomy with ileal pouch-anal anastomosis do well; however, properly identifying acute and chronic complications are paramount to managing and correcting these complications to allow for optimal pouch function and avoid pouch failure. Inflammatory conditions like pouchitis may require ongoing medical therapy, but surgical intervention may be needed to correct any underlying septic complication and to repair any structural disorders. Patients with signs of pouch failure may be candidates for pouch augmentation or redo pouch surgery and should be referred to high-volume centers before pouch excision is offered if the patient wishes to avoid a permanent ileostomy.