COMPLICATIONS AND THEIR MANAGEMENT AFTER RESTORATIVE PROCTOCOLECTOMY

The overall rate of complications after ileal pouch-anal anastomosis i s 60 %. This rate, however, includes complications such as bowel-obstr uction and hernias. Pouch-related complications occur after ileal pouc h-anal anastomosis with a frequency of 15-25 %. In an analysis of the recent literature the main risk factors are: tension of the ileal pouc h-anal anastomosis, anastomotic leakage, lack of protective ileostomy, pre operatively undiagnosed Crohn's disease and the experience of the surgeon. We classified pouch related-complications into (1) surgical complications (leakage, bleeding, pelvic sepsis, fistulas); (2) techni cal problems (long S-pouch spout, rectal cuff stenosis, etc.); (3) fun ctional problems (anal sphincter insufficiency, night incontinence, hy permotility, evacuation disorders); (4) pouchitis; (5) pouch neoplasia s. Pathogenesis, diagnostic features, and medical and surgical therapy are discussed in detail. In our own series of 11 pouch-redo operation s we had 6 pouch fistulas (3 related to Crohn's disease, 3 postoperati ve fistulas), 3 wrongly constructed pouches, 1 chronic pouchitis and 1 long S-pouch spout. In 3 cases the pouch had to be excised completely . Two patients remained with a permanent ileostomy. In 6 patients the pouch could be preserved on long term. Due to the technical complexity , the need to understand pathophysiology and the need for a differenti ated diagnostic procedure, this operation should be performed only in specialised centers.