This article reviews the current literature concerning pouch design, t
he need for a defunctioning ileostomy after the ileal pouch-anal anast
omosis, whether a mucosectomy should be performed, and whether a pouch
is safe in the setting of cancer. The J configuration appears to be s
atisfactory if sufficient length of terminal ileum is used. Functional
outcome does not appear to be affected if a mucosectomy is performed.
The need to defunction should be based on technical and patient-relat
ed considerations. Early cancer does not contraindicate ileal pouch-an
al anastomosis.