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Part II ♦ Specific Disorders Newer procedures, which preserve anal continence but remove the entire colon and rectum, are now in use. Currently, the most acceptable procedure is total proctocolec- tomy, which removes the mucosa and thus the risk of cancer, with the creation of an ileal pouch (reservoir) and anastomosis of the pouch to the anus (restores continence) ( Fig. 8-10 ). Late complications are common for this difficult disease, requiring a complex operation for long-term continence (Table 8-2).

Figure 8-10: After total proctocolectomy for ulcerative colitis, gastrointestinal reconstruction is accomplished by creation of an ileal J-pouch and anastomosis of the pouch to the anus. Table 8-2:  Common Late Complications after Ileal Pouch–Anal Anastomosis Pouchitis (30%–50%) Small bowel obstruction (11%–26%) Cuffitis (5%–14%) Pouch failure (5%–10%) Fistula (3%–12%) Sexual dysfunction—male and female (5%–20%) Cancer—cuff or pouch (rare) From Greenfield LJ, Mulholland MW, Lillemoe KD, et al., eds. Greenfield’s Surgery , 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2010. SAMPLE