Pouch surgery for ulcerative colitis in 2025: A narrative review

Restorative proctocolectomy with ileoanal pouch is the standard procedure in ulcerative colitis patients with medical refractory disease, dysplasia or in selected patients with Crohn's disease. The advent of biologics has reduced the rate of elective colectomies, the timing of surgery and the t...

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Published inBaillière's best practice & research. Clinical gastroenterology Vol. 77; p. 102017
Main Authors Vignali, Andrea, Sileri, Pierpaolo
Format Journal Article
LanguageEnglish
Published Netherlands Elsevier Ltd 01.08.2025
Subjects
Colitis, Ulcerative - pathology
Colitis, Ulcerative - surgery
Colonic Pouches - adverse effects
Humans
Ileoanal pouch
Laparoscopic IPAA
Minimally Invasive Surgical Procedures - methods
Proctocolectomy, Restorative - adverse effects
Proctocolectomy, Restorative - methods
Proctocolectomy, Restorative - trends
Restorative proctocolectomy
Severity of Illness Index
Trans-Anal IPAA
Treatment Outcome
Ulcerative colitis
Laparoscopic IPAA
Trans-Anal IPAA
Restorative proctocolectomy
Ileoanal pouch
Ulcerative colitis
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Abstract Restorative proctocolectomy with ileoanal pouch is the standard procedure in ulcerative colitis patients with medical refractory disease, dysplasia or in selected patients with Crohn's disease. The advent of biologics has reduced the rate of elective colectomies, the timing of surgery and the type of the surgical approach and increased the stages of the operation. to analyze the main chances in pouch surgery with a focus on staging, minimally invasive surgery and trans anal approach. the decision on the staging approach should be individualized according to disease severity, preoperative nutritional status, intraoperative variables and preoperative exposure to immunomodulators. A minimally invasive approach is recommended when feasible. Trans-anal ileal pouch is a promising technically demanding operation, subject to procedure specific risk and should be performed only by experienced surgeons. The minimally invasive approaches are evolving, but large-scale controlled studies are needed to confirm their efficacy and safety.
AbstractList Restorative proctocolectomy with ileoanal pouch is the standard procedure in ulcerative colitis patients with medical refractory disease, dysplasia or in selected patients with Crohn's disease. The advent of biologics has reduced the rate of elective colectomies, the timing of surgery and the type of the surgical approach and increased the stages of the operation.BACKGROUNDRestorative proctocolectomy with ileoanal pouch is the standard procedure in ulcerative colitis patients with medical refractory disease, dysplasia or in selected patients with Crohn's disease. The advent of biologics has reduced the rate of elective colectomies, the timing of surgery and the type of the surgical approach and increased the stages of the operation.to analyze the main chances in pouch surgery with a focus on staging, minimally invasive surgery and trans anal approach.AIMto analyze the main chances in pouch surgery with a focus on staging, minimally invasive surgery and trans anal approach.the decision on the staging approach should be individualized according to disease severity, preoperative nutritional status, intraoperative variables and preoperative exposure to immunomodulators. A minimally invasive approach is recommended when feasible. Trans-anal ileal pouch is a promising technically demanding operation, subject to procedure specific risk and should be performed only by experienced surgeons.RESULTSthe decision on the staging approach should be individualized according to disease severity, preoperative nutritional status, intraoperative variables and preoperative exposure to immunomodulators. A minimally invasive approach is recommended when feasible. Trans-anal ileal pouch is a promising technically demanding operation, subject to procedure specific risk and should be performed only by experienced surgeons.The minimally invasive approaches are evolving, but large-scale controlled studies are needed to confirm their efficacy and safety.CONCLUSIONThe minimally invasive approaches are evolving, but large-scale controlled studies are needed to confirm their efficacy and safety.
Restorative proctocolectomy with ileoanal pouch is the standard procedure in ulcerative colitis patients with medical refractory disease, dysplasia or in selected patients with Crohn's disease. The advent of biologics has reduced the rate of elective colectomies, the timing of surgery and the type of the surgical approach and increased the stages of the operation. to analyze the main chances in pouch surgery with a focus on staging, minimally invasive surgery and trans anal approach. the decision on the staging approach should be individualized according to disease severity, preoperative nutritional status, intraoperative variables and preoperative exposure to immunomodulators. A minimally invasive approach is recommended when feasible. Trans-anal ileal pouch is a promising technically demanding operation, subject to procedure specific risk and should be performed only by experienced surgeons. The minimally invasive approaches are evolving, but large-scale controlled studies are needed to confirm their efficacy and safety.
ArticleNumber 102017
Author Vignali, Andrea
Sileri, Pierpaolo
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Keywords Laparoscopic IPAA
Trans-Anal IPAA
Restorative proctocolectomy
Ileoanal pouch
Ulcerative colitis
Language English
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Snippet Restorative proctocolectomy with ileoanal pouch is the standard procedure in ulcerative colitis patients with medical refractory disease, dysplasia or in...
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SubjectTerms Colitis, Ulcerative - pathology
Colitis, Ulcerative - surgery
Colonic Pouches - adverse effects
Humans
Ileoanal pouch
Laparoscopic IPAA
Minimally Invasive Surgical Procedures - methods
Proctocolectomy, Restorative - adverse effects
Proctocolectomy, Restorative - methods
Proctocolectomy, Restorative - trends
Restorative proctocolectomy
Severity of Illness Index
Trans-Anal IPAA
Treatment Outcome
Ulcerative colitis
Title Pouch surgery for ulcerative colitis in 2025: A narrative review
URI https://www.clinicalkey.com/#!/content/1-s2.0-S1521691825000447
https://dx.doi.org/10.1016/j.bpg.2025.102017
https://www.ncbi.nlm.nih.gov/pubmed/40769613
https://www.proquest.com/docview/3237450452
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