[Restorative proctocolectomy: which kind of reservoir?]

Functional results after ileoanal anastomosis are better when a reservoir is used than when a straight reconstruction is carried out. Designs include the three loop (S) with and without a distal ileal segment, two loop (J), four loop (W) and lateral isoperistaltic (H). The evidence available indicates that frequency of defecation is inversely related to the size of the reservoir. It has also shown that a distal ileal segment may relate to failure of spontaneous evacuation. Non randomised studies suggest that larger reservoirs (eg S or W) give better results than a J reservoir. There is no apparent difference in the mobility of the reservoir to descend to the anal level whatever construction is used. Te particular design probably does not matter greatly provided: a) the reservoir is of sufficient capacity (three or four loop, or long double loop), and b) evacuation is facilitated by joining the pouch directly to the anus, thereby avoiding a distal ileal segment.