Ileostomy or Ileal Pouch Anal Anastomosis: Shared Decision-Making in the Surgical Management of Ulcerative Colitis

Up to 30% of patients with ulcerative colitis will ultimately require surgery. Generally, surgery for ulcerative colitis consists of total proctocolectomy with either end ileostomy or ileal pouch anal anastomosis, which may be performed in 1 to 3 stages. There are risks and benefits specific to undergoing permanent ileostomy creation or ileal pouch anal anastomosis, with each procedure resulting in different and dramatic changes in a patient's day-to-day life. Because most patients are eligible for either procedure, patient preferences are an important consideration when creating a treatment plan. Shared decision-making is a collaborative process where surgeons and patients work together to make a treatment decision that is evidence-based and incorporates patient values. Here, we review the differences between end ileostomy and ileal pouch anal anastomosis, focusing on the risks and lifestyle considerations that may inform treatment decisions, as well as the available tools to support shared decision-making during surgical consultations.