Colostomy-Sparing Surgery

Ileal Pouch-Anal Anastomosis

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The ileal pouch-anal anastomosis (IPAA) is a complex surgical procedure developed to avoid a permanent stoma (opening for collecting waste) in cases where the entire colon and rectum needs to be removed. This procedure is most often used to treat patients with chronic ulcerative colitis and inherited syndromes associated with colon cancers (For example, familial adenomatous polyposis, which carries a nearly 100 percent risk of colon cancer).

Since 1981, when the IPAA procedure was first described, Mayo Clinic surgeons have performed more than 2,300 IPAA procedures, the largest experience of any medical center in the world.

The IPAA procedure involves removal of the entire colon and rectum with preservation of the anus and sphincter muscles. After removal of the colon and rectum, the surgeon constructs a pouch from the end of the small intestine and attaches it directly to the anus. In order to allow time for the pouch to heal, a temporary ileostomy (opening in the front of the abdomen) is created. The ileostomy is reversed a few months later in a second operation and the patient begins to pass bowel movements through the anus, with only slight alterations in the frequency of bowel movements. In most cases the IPAA procedure can be performed laparoscopically, which minimizes the incision length and decreases postoperative discomfort and the hospital stay.

Recent studies have shown that 92 percent of patients who had this procedure at Mayo Clinic had a successful outcome and are very satisfied with their functional result. Furthermore, Mayo surgeons have just reported on results from more than 400 patients who have had their IPAA for greater than 15 years. The findings of this study demonstrate that the IPAA is durable over the patient's lifetime, without significant changes in function.

The Mayo Clinic also is a leader in the use of minimally invasive surgery for this procedure, having performed nearly 200 laparoscopic IPAAs during the last five years. The outcomes in patients who have had laparoscopic IPAA are similar to patients who had the traditional open surgery, but with better cosmetic results, less pain and shorter hospital stays.