The Augmentation Pouch: Adding an S Pouch to a Straight Ileal-Anal Anastomosis.

Background: Straight ileo-anal anastomosis in patients undergoing proctocolectomy for ulcerative colitis or familial adenomatous polyposis is associated with diarrhea, incontinence, and anal excoriation. Techniques to improve function include takedown of the ileo-anal anastomosis with construction of a pouch and redo ileal pouch-anal anastomosis, or multiple ileal myotomies. Here is a technique for augmenting the ileum without taking down the ileo-anal anastomosis.

Impact of innovation: Improves function in patients with straight ileo-anal anastomosis.

Materials and methods: The apex of redundancy in the loop of distal ileum is pulled down toward the pelvis alongside the ileum going down to the anastomosis, and an S pouch is created. The apex of the loop is placed as close to the existing ileo-anal anastomosis as possible. A diverting ileostomy is constructed.

Preliminary results: Four male patients with familial polyposis underwent this procedure. All recovered without complication, retained their S pouch, and noted improved function. One patient seen after formation and immediate excision of a J pouch underwent straight ileo-anal anastomosis with immediate construction of an augmentation S. There were no complications. Function is acceptable.

Conclusions and future directions: Augmenting the terminal ileum above a straight ileo-anal anastomosis without disturbing the anastomosis is possible and may allow the patients to avoid a permanent ileostomy.