Surgical options in ulcerative colitis

This article reviews the current literature concerning pouch design, the need for a defunctioning ileostomy after the ileal pouch-anal anastomosis, whether a mucosectomy should be performed, and whether a pouch is safe in the setting of cancer. The J configuration appears to be satisfactory 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-related considerations. Early cancer does not contraindicate ileal pouch-anal anastomosis.