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Management of Ileal Pouch Strictures and Anal Stricturing Disease: A Clinical Challenge

  • Jean H. Ashburn
  • Tracy L. Hull
Chapter

Abstract

Restorative proctocolectomy with an ileal pouch-anal anastomosis (IPAA) has been an ideal surgical option for patients with chronic ulcerative colitis (UC), familial adenomatous polyposis, and selected patients with colorectal cancer and Crohn’s disease for nearly four decades. In most cases, patients enjoy excellent quality of life with a durable surgical and functional result, avoiding the need for a permanent conventional ileostomy.

Despite great success, patients with IPAA may suffer from several pouch-related complications that are a challenge for the patient and clinician. IPAA-associated fibrotic stricturing disease is one such challenging complication that requires thoughtful judgment for successful management. Treatment of fibrotic strictures of the IPAA requires a multidisciplinary approach involving medical, endoscopic and surgical input for accurate diagnosis, effective treatment, and improvement of quality of life.

The focus of this review is to provide a structured approach to the challenges that the clinician encounters when faced with a patient with IPAA-associated fibrosis and stricturing disease and to discuss the surgical options that alleviate the morbidity caused by ileal pouch fibrosis when medical treatments fail.

Keywords

Ileal pouch Surgery for IPAA stricture Ileostomy Multidisciplinary ileal pouch team Ileal pouch failure Pouch disorders Pouch stricture Ileal pouch fibrosis 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Colorectal SurgeryDigestive Diseases and Surgery Institute, Cleveland Clinic FoundationClevelandUSA

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