Ileoanal Anastomosis: Potential Risks & Complications

Ileoanal anastomosis (IPAA, J-pouch) restores continuity after proctocolectomy for ulcerative colitis or familial adenomatous polyposis. While effective, complications occur.

Early Complications (≤30 days)

• Anastomotic leak: 5–10%; presents with pelvic pain, fever, leukocytosis. May require diversion, drainage, or reoperation.
• Small bowel obstruction: 10–15%; adhesions, volvulus. Often resolves with NG decompression.
• Bleeding: Pouch or anastomotic; usually self-limited.

Late Complications

• Pouchitis: Inflammation of pouch mucosa; 20–50% at 5 years. Symptoms: urgency, frequency, bleeding, cramps. Treated with antibiotics (cipro/metro), probiotics, biologics if chronic.
• Anastomotic stricture: 5–15%; dilation or surgical revision.
• Fecal incontinence: 10–20% daytime; higher at night. Managed with loperamide, fiber, biofeedback, sacral nerve stimulation.
• Cuffitis: Retained rectal cuff inflammation; topical mesalamine/steroids.
• Sexual dysfunction: Erectile dysfunction, retrograde ejaculation (males); dyspareunia (females) from pelvic nerve injury.
• Pouch neoplasia: Low risk; surveillance pouchoscopy every 1–3 years.
• Fistula: Pouch-vaginal, pouch-perineal; complex, often requires diversion.

Quality of Life

Most patients achieve 4–6 bowel movements/day, good continence, and high satisfaction. Preoperative counseling on realistic expectations is essential.