Functional Disorders of the Ileal-Anal Pouch: A Systematic Review

Abstract

BACKGROUND: The ileal pouch-anal anastomosis is a boon to patients needing proctocolectomy but maintains per anal function through anatomic and physiologic compromises. The state of pouch function is hard to define as pouch anatomy is not normal and pouch physiology is a distortion of normal defecation. Patients with pouches develop multiple symptoms; some expected, some disease related, and some the result of surgical complications. It is important to understand the cause of pouch related symptoms so that the appropriate management is offered. OBJECTIVES: Review pouch symptoms and discuss their likely cause. Review the literature on pouch function and dysfunction and provide clarity to the confusion. DATA SOURCES: PubMed and Cochrane database search using the terms “ileoanal pouch function” and “ileoanal pouch dysfunction.” STUDY SELECTION: A total of 553 articles from 1983 to 2023 from “ileoanal pouch function” and 178 from “ileoanal pouch dysfunction” were reviewed. Nine studies appeared under both headings. Case studies, duplicate publications, and articles concerning pouch diseases were excluded. MAIN OUTCOME MEASURES: Definitions of pouch function and dysfunction, methods of describing and scoring symptoms, understanding of expected changes in pouch function given the nature of the surgery. RESULTS: Twenty-seven studies were reviewed from the ileoanal pouch dysfunction search, and 38 from ileoanal pouch function. 3 studies tried to define normal pouch function, 10 attempted to measure pouch function, and 4 aimed at scoring pouch function. Only 3 papers addressed pouch physiology. CONCLUSIONS: Most studies of pouch function and dysfunction don’t consider expected changes in the physiology of defecation that follow restorative proctocolectomy. This means that most studies of pouch function produce conclusions that lack an important dimension. See symposium video.