What can I expect after "pouch" surgery?
Ileal pouch anal anastamosis (IPAA) is usuallythe procedure of choice for young, healthy patients with ulcerative requiring colectomy since it requires 2-3 significant surgeries. After completion of the ileal pouch, or neorectum, from multiple loops of small bowel a continuous intestine is re-established.
After surgery it is expected that there will be diarrhea 5-10 times per day, sometimes resulting in dehydration and requiring aggressive anti-diarrheal mediciations. Over the course of weeks to months the diarrhea tapers to an average of 4 soft bowel movements per day.
There is rarely an impact on bowel absorption after IPAA, but because the terminal ileum is used to construct the neorectum with some loss of normal function, there may be B12 deficiency requiring supplemental injections.
A majority of patients develop at least one episode acute pouchitis after IPAA. It results in inflammation of the pouch causing stool urgency and rectal pain. Acute pouchitis responds to short courses of antibiotic or corticosteroid therapy. In about 5% of patients the pouchitis is recurrent, or chronic, requiring frequent or even continuous antibiotics, corticosteroids, or probiotics. Rarely, chronic pouchitis requires pouch resection and creation of an end-ileostomy.
Finally, Crohn’s disease diagnosed after surgery for suspected ulcerative colitis occurs rarely, but more often in patients with indeterminate colitis. Surgical revision to end-ileostomy is usually required.