What type of ileal pouches are used?
- Although higher-volume pouches are advocated (W = quadruple, S = triple, and J = two-limbed), the long-term functional results may not be all that different.
- The author prefers a long (15 cm) J pouch (when feasible in one stage) preserving the anal transition zone. The procedure has classically been two-staged, with construction of a temporary ileostomy followed at an interval by ileostomy takedown.
- Recent experience has shown that the morbidity of a one-stage IPAA may be less if the patient is taking no or low-dose steroids and the operation is performed without complication.
- Because there is really only one shot at getting it right (pelvic sepsis significantly diminishes ultimate pouch function), intraoperative judgment is at a premium.
