Ileo-anal pouch - Knowledge (XXG)

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able to 'redo' the anal anastomosis by removing excess rectum. Similarly, if a standard cuff of 1–2 cm was used, a revision surgeon still might be able to remove that and lower the pouch onto the anus. In this scenario, the surgeon typically tries to save and reuse the existing pouch, but this is not always possible if the pouch is also damaged from complications or has technical flaws. It might not be possible for an experienced salvage surgeon to redo an anal-anastomosis that has already been hand sewn or has a complication like a fistula or sepsis damage too close to the anus because this presents a surgical situation that is high risk to not heal properly and cause more complications.

253:(FAP) patients and are sometimes controversially considered cured of problematic symptoms after pouch creation due to the removal of disease activity in the colon and rectum, there are still many complications that can arise. While life with a pouch is typically viewed by some people plus some medical professionals as a significant improvement compared to life with an ileostomy, patients living with a pouch may still face daily pains and discomforts including the inability to sleep through the night, a changed diet, severe or frequent gas pain, nutrient deficiencies, and the inability to digest certain foods. 661:: A stapled anal anastomosis is done using a tool that seals the pouch to the anal canal. Unlike with a hand sewn anastomosis that usually does not leave any mucosal layer, a staple pouch will retain 1–2 cm of rectal mucosal layer because the staple needs something to 'grab' to anastomose the pouch. This retained 1–2 cm of rectum is referred to as the 'cuff'. The cuff can retain disease and cause minor or more serious complications for some pouches. The ideal location for the staple is considered it be 1 cm above the dentate line at the level of the anorectal junction. The 134:

theory to a breast reconstruction after a mastectomy removes diseased breast tissue. Before a pouch is created, a person's diseased colon and rectum are removed. After disease removal, standard medical screening exams for pouch candidates include but are not limited to biopsies, radiology imaging, sphincter function tests, fertility consultations for people of childbearing age with the wish to get pregnant, and psychological support due to intensity of the pouch operations.

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disease can be retained in the small remnant. Active disease feels similar to ulcerative proctosis when the full natural rectum was in place. It is also medically treated the same way ulcerative proctosis was before any surgery. Even if the entire colon and rectum are removed to stop disease activity in this area, the underlying reasons for the expression of the disease in the large bowel and rectum's mucosal layer remain with the person.

710:(IVF) treatment a younger woman experiencing pouch related infertility many need to rely on to conceive, many not legally be available to the older woman if she later learns past the cutoff-age that her situation requires IVF to get pregnant. Most women are not aware of age limits to IVF treatment using their own eggs - especially if they are living, studying, or working away from their hometown or abroad at the time of their operations. 332:

While ulcerative colitis pouch patients may experience a dysbiosis sparked type of inflammation more than people who get a pouch because of cancer or FAP, pouchitis can be caused by a number of factors in any pouch. Pouchitis is grouped into four main categories of origin: inflammatory, mechanical, surgical, or functional. Pouchitis, meaning pouch inflammation from various root causes, can be a driver of pouch dysfunction for some.

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caused by Crohn's disease are often treated with biological therapy while a fistula from an anastomotic leak requires different therapies as biologics rarely help close a leak in a surgical suture or staple line of the pouch. Different potential treatment options for an anastomotic fistula depend on the leak's location and include but are not limited to ENDO-Vac sponge, needle-knife therapy, draining seton, or cutting seton.

494:(BSG) and the European Crohn's and Colitis Organisation (ECCO) recommend that pouches should ideally be created at facilities that have specialized pouch centers when possible due to the high level of technical skill required for multidisciplinary management of a pouch. Numerous studies also show that there is a direct relation between the success of a pouch and the experience a surgeon has with previous pouch creations. 604:(also known as a "loop ileostomy"). After a healing period determined by the surgeon based on the individual patient, the second step is performed, in which the ileostomy is reversed. This step is referred to as ileostomy reversal or takedown. The reason for the temporary ileostomy is to allow the newly constructed pouch to fully heal without waste passing through it, thus avoiding leaks that can lead to infection. 631:. After the subtotal colectomy, the second operation consists of pouch creation with installation of a double or loop ileostomy to protect the pouch while it heals. Waste continues to exit through an opening in the abdominal wall. Then usually three to six months later when surgeons feel the pouch has healed, the loop stoma is reversed and the pouch becomes fully operational restoring intestinal continuity. 1074:

surgery will determine which method an experienced revision surgeon recommends as the surgical approach most likely to produce the best result possible. Revisional surgeries are considered highly specialized. They require a skilled surgeon with complex revisional experience for the best chance at a good result. Many expert pouch surgeons advocate for early referrals to specialists for best outcomes.

269:'ulcerative colitis'. Therefore, ulcerative colitis is considered 'cured' of the problematic disease activity in the colon and rectum only, after both the large intestine and rectum are removed. Reasons to remove this mucosal layer include severe discomfort that reduces quality of life, bowel perforation from inflammation, and development of tumors that are cancerous from long-term inflammation. 649:: Surgeons typically use this type of anal anastomosis to remove all of the rectal mucosal layer, although very small islands may still remain. A hand sewn anal anastomosis may be necessary when ulcerative colitis, FAP, or cancer patients retain disease in the anal canal to remove all remaining disease. When a hand sewn anastomosis is performed, it is typically placed at level called the 394:

intestinal pouch surgery became more common, the J-pouch eventually became the dominant shape. J-pouches are easier for surgeons to construct than the hand sewn S or W formations because the Js are from two loops of ileum plus with the invention of the stapler, Js could be stapled, instead of hand-sewn. J-pouches are considered faster and easier to make over Ss and Ws.

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anus. This retained 1 to 2 cm of rectum can therefore, sometimes retain ulcerative colitis in UC pouches. In contrast, hand sewn pouch-anal anastomosis' typically do not retain any mucus layer but sometimes a cuff is also used and it might cause discomfort for some hand sewn pouches. Cuffitis is clinically diagnosed by symptoms plus endoscopically (pouchoscopy).

308:. People who need to have their colon and rectum removed are usually presented with several options including total proctocolectomy with end ileostomy ("Barbie" or "Ken" butt), colectomy with rectum left in place, pelvic pouch (ileo-anal pouch / IPAA), ileo-rectum anastomosis (IRA), or continent ileostomy such as a Kock pouch, for example, if someone has weak 747:

daytime incontinence, nocturnal seepage, and/or rectal bleeding. Studies show pouchitis occurs more often in people who got their pouch because of ulcerative colitis rather than familial adenomatous polyposis (FAP) which suggests that the pathogenic (microbial) background of UC may contribute to the development of pouchitis in some pouches.

114:) back on themselves and stitching or stapling them together. The internal walls are then removed thus forming a reservoir often referred to as a 'pouch'. The reservoir is then stitched or stapled into anal area where the bottom of the rectum was. The first pouch anal-anastomosis surgery in the world was performed by British surgeon 1052:. When a pouch is constructed small amounts of ileum are lost to the stomas and any stoma revisions. The pouch itself is also made from ileum. If a pouch is defunctioned (also explained as disconnected and/or pouch failure) the person also loses this extra amount of ileum when the pouch is disconnected from the digestive tract. 141:. A Kock pouch is also called a 'continent ileostomy' because while a person has a pouch constructed inside their body, it is located near the abdominal wall and empties via a stoma from the ileum at the person's convenience. A Kock pouch does not restore the anal function. The procedure was first premiered by Finnish surgeon 503:

pouch nurse is usually an extension of the IBD nursing team or stoma nurse team. However, pouch nurses are also trained for pouches created from injury, infection, FAP, cancer and other reasons. Pouch nurses provide healthcare, advice, and support specific to the concerns of pouch patients before and after surgery.

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intestine (ileum) to the anus. It was described by the German surgeon Nissen in 1934 and American surgeons Ravitch and Sabiston in 1947. The ileum-anal anastomisis was reported to have a high of frequency of liquid movements making it uncomfortable for many people. It was also a surgical advancement from the

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Having an intestinal pouch is considered a rare condition. Some national organizations and specialist charities usually associated with inflammatory bowel disease (IBD) or ostomies provide some information to people considering or who have chosen to undergo elective pouch surgery. Some of the larger

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People with a pouch can follow any diet they choose while monitoring their overall nutritional status due to the loss of bowel causing absorption issues. People diagnosed with vitamin or mineral deficiencies may be prescribed injections or tablets. Others may be referred to a nutritionist to design

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If a repair or redo can not be undertaken because of factors like severe disease, or a repeat surgery fails, or a patient wishes to have their pouch removed with undergoing additional surgery, a pouch excision operation can be performed to remove the pouch. Removal of a pouch is a big operation that

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People with a pouch are at a further health risk if they experience excessive potassium loss due to things like vomiting, diarrhea, and prescription medications that increase urination. This is because potassium is a key electrolyte that helps regulate the heart and if levels become too low, a person

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Most expert pouch centers plus national gastroenterology society guidelines worldwide recommend a cuff be no longer than 2 cm with the aim to staple the pouch at the level of the anorectal junction, leaving about 1 cm of rectum or mucus layer behind for the staple to attach the pouch to the

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After exams and tests, pouchitis is divided into two categories based on findings: idiopathic or secondary. In idiopathic pouchitis the cause of inflammation is still unclear. With secondary pouchitis there is an association with a specific causative or pathogenetic factor. Secondary pouchitis can be

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The general public's lack of widespread knowledge about IVF regulations also applies to child adoption laws. Most men and women are not aware that some countries place age bans on adopting newborns. For example, in Germany adoption of an infant is prohibited if a parent is over the age of 40 years.

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is the point where anal skin changes to the colonic mucosal layer that covers the rectum and large intestine or colon. Numerous studies have been published over the years showing that excessive length of the cuff can be a contributor to pouch failure due to retained disease and/or pouch dysfunction.

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in London as an augmentation of the S and J pouches with the aim to reduce frequency of movements. Unlike the S-pouch, it does not have an exit conduit at the bottom. It is essentially a combination of two Js to create the larger capacity W. The W-pouch is anastomosed directly to the anus the same

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During a total proctocolectomy, a surgeon removes a person's diseased colon, rectum, and anus. For the ileostomy, the end of the small intestine is brought to the surface of the body through an opening in the abdominal wall for waste to be removed. People with ileostomies wear an external bag, also

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surgery, the premium cost could potentially be higher than if the person did not have a pouch because of the higher cost of care related to having a pouch. While higher prices might only apply in certain circumstances for health insurance, it is almost always the case for life and travel insurance.

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Additionally, liquid stool directly from the ileum no longer benefits from the colon removing digestive enzymes before a bowel movement. This means liquid stool produced by the ileum can be aggressive on the skin around the anus. Discomfort, including experiencing itching and/or burning around the

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If a person's pouch body is troubled, then an experienced pouch surgeon may be able to make a second pouch if the person's previous surgeries retained enough ileum to still safely create a second pouch. Experienced revision surgeons will not create a second pouch if it risks putting the person into

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Some people undergoing IPAA/RPC may be later diagnosed with underlying Crohn's disease because the disease likely had not fully expressed itself at the time of surgery. Crohn's disease of the pouch is associated with high failure rates. Pouches may experience fistula leaks that cause pelvic sepsis

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For pouches with acute idiopathic pouchitis, response to antibiotic therapy is typically examined clinically by asking the patient if they have experienced an improvement with their symptoms plus looking endoscopically using a pouchoscopy after completing antibiotic therapy. While endoscopic mucosal

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In addition to specialized doctors for colorectal surgery, gastroenterology, pathology, radiology, gynecology and urology, fertility, psychology, nutrition, and rehabilitation including physiotherapy, facilities with pouch centers often also have a specialized pouch nurse or pouch nursing team. The

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It is important to understand that pouch surgery does not cure a patient of ulcerative colitis, removal of the diseased mucosal layer in the colon and rectum cures the disease in the colon and rectum only, if the entire colon and full rectum are removed. For example, if a rectal remnant remains, UC

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are suitable candidates for an ileo-anal pouch due to the risk of the disease occurring in the pouch. Crohn's disease can manifest in many different parts of the digestive tract, so the removal of the colon and creation of a pouch, while alleviating symptoms that occurred in the large intestine plus

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Many people with a pouch eat their normal diet after surgery while others have to alter their diet due to discomfort when digesting certain foods. Others experience more watery output after eating specific foods like processed sugary snacks which may require some people with pouches to use dietary

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Occasionally, an experienced revision surgeon may need to alter the shape of the original pouch they are attempting to rescue. For example, when there is not enough ileum to create a second pouch or if the person's anatomy (mesentery and/or vascular supply) does not allow for the pouch to reach to

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Removal of the entire large intestine (colon) and amounts of the terminal ileum at the end of the small intestine leads to fluid and nutritional absorption issues for all pouches. The colon absorbs water, salts, and some key nutrients. Dehydration can occur if a person does not get enough fluids.

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This happens when the surgeon fires the linear stapler and it malfunctions. Usually the flaw is not noticed until after surgery is complete during first pouchoscopy. The pouch is called a "U" bend because instead of stapling the two full sections of ileum together into a "J", the stapler does not

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If a person later diagnosed with Crohn's disease of the pouch wishes to keep their pouch operational, in some circumstances medical management might be possible. Typically this is done with the prescription of biologics. It may take more than one drug prescription to find a suitable biologic that

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suppositories or enemas are sometimes prescribed first (brand names include Asacol, Canasa, and Pentasa). If those do not provide enough relief then treatment might be escalated to corticosteroid suppositories or enemas such as Budesonide. Biological therapy may be prescribed if all other medical

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without a Kock pouch functions constantly, meaning, a patient with ileostomy by itself is incontinent because waste is always moving down the bowel and thus the need for an external appliance bag. Kock pouch surgery is also elective surgery that only provides a reconstructive benefit after disease

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Pouch surgery is elective, meaning it is entirely optional, and should be done on the basis of choice by people who doctors deem suitable for a pouch after medical evaluations. Pouch surgery is considered reconstructive with the benefit being for quality of life and not disease removal, similar in

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After the colon is removed a person does not have the ability to form solid stool. Because waste will always be liquid, people experience several movements per day when their pouch's capacity is full. The aim of pouch surgery is 4-8 movements per day, although, some people experience many more.

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Ileo pouch-anal anastomosis surgery (IPAA) also called Reconstructive Proctocolectomy (RPC) was originally designed and premiered to improve quality of life for people who needed to have their colon and rectum removed because it avoided the need for stool collection in an external bag and restored

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If a pouch has a troubled anal-anastomosis that leaks and causes sepsis or if a person retained more than the recommended amount of rectum (a rectal cuff of no more than 2 cm follows global colorectal surgery recommendations for an ulcerative colitis person), then an experience surgeon may be

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Sometimes the root cause of pouch dysfunction can be managed with more conservative methods such as using an ENDO-Vac sponge for an anastomotic defect that leaks, needle knife therapy for fistulas and sinuses, or cutting seton for a low lying peri-anal fistula that does not impact the pouch's anal

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Cancer is a rare event after a pouch is created. However, retained rectal mucosa can develop dysplasia over time especially if cuffitis is an ongoing complication. Cancer can also develop in the pouch when there has been long-term pouchitis (inflammation of the pouch for any reason). People who

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Cuffitis is inflammation of the retained rectal 'cuff' usually in a stapled pouch-anal anastomosis or the spot where the intestinal pouch was attached to the anus to restore anal evacuation. Symptoms are typically similar to ulcerative proctosis for ulcerative colitis pouches including burning in

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A fall in female fertility was reported in a Danish study by Olsen et al. in 1999 showing a drop after pouch surgery to less than 50% of the normal population. There are well researched risks to fertility for both men and women. Highly specialized pouch centers globally typically offer fertility

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The pouch can also be formed as part of a three step procedure for people of childbearing age who have not completed their family planning. When there is a wish for pregnancy, the process can be paused after subtotal colectomy until family planning is complete if doctors feel remaining disease in

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It is generally considered best practice to create and manage ileum pouches at a facility that has specialized and experienced clinicians specifically for intestinal pouch care. Individual doctors and facilities can communicate their level of pouch experience to potential pouchees, people already

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collaborated with a number of leading hospitals globally to share pouch surgery knowledge Zane Cohen is credited with being a leader in Canada's development of pouch surgery. Rolland Parc was a force behind its early evolution in France. Gilberto Poggioli is credited with being at the forefront of

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The original Sir Alan S-pouches had a bit of intestine at the bottom of the design that often made them difficult to evacuate. Some patients later underwent advancement surgery to remove the extra tip of small intestine and lower the pouch directly onto the anus to remedy evacuation difficulties.

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Parks' pouch surgery was originally envisioned as a quality of life enhancing procedure for people who needed to have their colon and rectum removed. People who opted to have the procedure would be able to avoid an ileostomy by restoring intestinal continuity with elective, or optional, ileo-anal

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The most common complication of pouch surgery is an umbrella term called pouchitis that encompasses many causes of inflammation of the pouch. The word 'pouchitis' simply means 'pouch inflammation' similar to 'tonsillitis' meaning 'tonsil inflammation' or 'sinusitis' meaning 'sinus inflammation'.

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condition. The main risk UC presents is typically inflammation that causes ulcers in the lining of the colon and rectum. This common expression happens in the mucosal layer of the intestine that is only present in the colon and rectum (not the small intestine), which is why the disease was named

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Magro, Fernando; Gionchetti, Paolo; Eliakim, Rami; Ardizzone, Sandro; Armuzzi, Alessandro; Barreiro-de Acosta, Manuel; Burisch, Johan; Gecse, Krisztina B.; Hart, Ailsa L.; Hindryckx, Pieter; Langner, Cord; Limdi, Jimmy K.; Pellino, Gianluca; Zagórowicz, Edyta; Raine, Tim; Harbord, Marcus; Rieder,

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A rare risk to male fertility is nerve damage that impairs or prevents ejaculation. Risks to fertility for women include removal of the rectum reducing fertility by at least 50%, a dysfunctional pouch sparking a hostile environment in the pelvis preventing embryo implementation in the uterus and

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Gregory, Martin; Weaver, Kimberly N; Hoversten, Patrick; Hicks, Stephen Bradley; Patel, Devin; Ciorba, Matthew A; Gutierrez, Alexandra M; Beniwal-Patel, Poonam; Palam, Sowmya; Syal, Gaurav; Herfarth, Hans H; Christophi, George; Raffals, Laura; Barnes, Edward L; Deepak, Parakkal (20 August 2019).

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Sometimes people are told when pouch surgery is recommended that they will be 'cured'. This is misleading on a number of levels including when it comes to obtaining various insurance policies. A person will reasonably believe that there is no longer any problem to worry about. However, once a

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Pelvic floor dysfunction is a common complication of pelvic surgery. The Mayo Clinic believes it is an under reported complication of IPAA/RPC surgery with up to 75% of pouch patients experiencing non-relaxing pelvic floor dysfunction. Biofeedback therapy is the main treatment for pelvic floor

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A pouch can either tilt or twist when stapled onto the anus causing prolapse. Pouch prolapse is also sometimes referred to as a floppy pouch. Pouch prolapse from a pouch being tilted or twisted can also cause pouch fistulas to develop, especially pouch-vagina fistulas. Prolapse can also happen

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Immunoglobulin related diseases can also cause problems for a pouch. The two most common that are biopsied for are IgG and IgG4. IgG molecules can initiate inflammatory reactions, both good and bad. When the autoimmune reaction is inappropriate, a pouch might have problems with IgG. IgG4 is a

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Standard treatment of pouchitis when first reported (acute pouchitis) without any other obvious cause identified such as infection or anal join leak (fistula) is oral antibiotics for two weeks, typically ciprofloxacin 500 mg every 12 hours. Alternatives to ciprofloxacin for initial therapy

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When a pouch fails, suitable patients can choose to undergo surgery to repair the pouch or completely redo a pouch's anal-anastomosis or redo the entire pouch (if enough terminal ileum remains to produce a second pouch). The cause of the problem that triggered a person's need for pouch salvage

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Narrowing of the anal canal under the pouch can cause evacuation difficulties. Anal stricture can be a cause of pouch failure if not managed properly. Anal stricture is a common complication of pouch surgery. It is treated with dilatation or stretching under anesthesia. Some people are also

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Most fistulas will connect from an anastomotic leak to another area of the body such as a pouch-vagina fistula, perianal fistula, or presacral fistula with pelvic collection. In some circumstances fistulas develop years after pouch creation due to the development of Crohn's disease. Fistula's

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is a general term that refers to a wide spectrum of diseases and conditions that cause inflammation of the pouch. It is a common complication after IPAA/RPC. People report many symptoms including abdominal pain or cramps, increased bowel frequency, urgency of movements, strong evacuation urges,

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in 1976 in London. It was later found that the 2 cm conduit caused some people evacuation difficulties. Some people who received the earlier S-pouch design with the conduit, later underwent revision surgery to remove the conduit, if they experienced evacuation difficulties. Further, the

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Additional contradictions that may prevent a person from being able to undergo pouch surgery include but are not limited to weak sphincter muscles, advanced age (elderly) due to the higher risk of fecal incontinence, pelvic radiation therapy, and women with a history of obstetric complications.

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The treating hospital at time of pouch surgery should inform potential pouch candidates about possible restrictions because restrictions can be related to specific insurers, local rules, national regulations, and/or universal regulations. In most cases if insurance can be obtained after pouch

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The experience of learning how to use a newly functional anal pouch can be distressing for some. Sharp pains, explosive moments, and anal seepage are common initial sensations. Specialized pouch centers often have a pouch nurse that educates a person for how to safely empty the pouch without

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Ileo pouch-anal anastomosis (IPAA) surgery is generally viewed as providing benefits over living with an ileostomy from a total proctocolectomy. However, not all people may consider extra surgery as a 'benefit' and therefore, some people opt to forgo the pouch option and remain living with an

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Intestinal obstruction after ileal pouch-anal anastomosis (IPAA) surgery can occur due to various reasons such as adhesions (scar tissue ), strictures (narrowing at the anastomosis site), and Pouchitis (inflammation of the ileal pouch). Perforation at the site of attachment of the ileum to the

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These adoption age bans combined with the risk of pouch related fertility complications, plus potential IVF age cut-off limits then increases the need for a person to plan to preserve fertility before pouch surgery commences in order to improve chances of later completing a wish for a family.

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Sir Alan Parks' ileo pouch-anal anastomosis (IPAA), was a surgical advancement from the ileoanal anastomosis procedure developed in the 1940s. With an ileum-anal anastomosis, the entire colon and rectum were removed. Next a surgical join (anastomosis) was used to connect the end of the small

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is an autoimmune condition that causes inflammation in the small intestine after gluten is eaten. It can cause pouchitis symptoms and discomfort. Some pouches that are celiac initially get misdiagnosed with Crohn's of the pouch. Celiac disease is typically diagnosed by biopsy of the pouch.

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In 1980, surgeons in Japan published the first study on the J-shaped pouch. J. Utunomiya is created with its creation. The J-shaped pouch design eliminated the 'conduit' or bit of intestine at the bottom of Sir Alan Parks' S-pouch formation making it easier for people to empty a J-pouch. As

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It is also important for people with pouches to know before they opt to undergo pouch surgery that not all countries provide health insurance coverage consistently or without interruption. For example, citizens of countries with nationalized healthcare services lose access if they establish

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The process of adjusting to life with an anal pouch can take many months. Mayo Clinic research estimates that up to 75% of people with a pouch might experience some level of pelvic floor dysfunction after pouch surgery. For pouches that are difficult to evacuate or experience anal seepage,

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Akiyama, Shintaro; Ollech, Jacob; Rai, Victoria; Glick, Laura; Singer, Jorie; Karpin, Jordan; Rodriguez, Tina; Yi, Yangtian; Shaffer, Seth; Cohen, Russell; Hurst, Roger; Hyman, Neil; Dalal, Sushila; Sakuraba, Atsushi; Pekow, Joel; Rubin, David (1 February 2020). "24 Endoscopic and Clinical

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Women who choose the option to undergo pouch surgery before childbirth, should also undergo a fertility evaluation before surgery that includes an egg preservation consultation especially if she is over the age of 35 years. With the pouch surgery potentially reducing fertility, the

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While most people who undergo elective reconstructive pouch surgery have either no issues or occasional minor discomfort, some pouches experience more serious complications that need medical management with a variety of therapies including medication and/or additional surgery.

889:(C-diff) might also be treated with probiotics just as a C-diff infection in a person who still has their colon would be treated. Probiotics that are prescribed for pouchitis (specifically pouchitis diagnosed as being caused by dysbiosis) are often also prescribed for C-diff. 489:

Intestinal pouches are considered optional reconstructive procedures to be done by the patient's choice since pouch surgery itself does not cure disease. Pouch surgery can only take place after disease is removed. Many national gastroenterology associations including the

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the anus. This means the shape of a J-pouch may be transformed into an S, W, or even an H to repurpose functional ileum from the primary, or first pouch surgery, when retaining the original shape would not be successful but altering it could rescue the pouch situation.

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Pouchitis is diagnosed based on the presence of symptoms together with endoscopic and histological evidence of pouch inflammation. For example, biopsies may be taken during a pouchoscopy (a camera exam like a colonoscopy but for the pouch) to rule out infection from

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anastomosis (and many not even be related to the pouch itself). When a more conservative method will not work or an attempt fails, bigger surgicial salvage procedures are then recommended, if the operation will have a chance to succeed and restore quality of life.

242:' including optional and patient's choice. Pouch reconstruction should never be offered as the only option to a person because it is elective and should be a voluntary choice offered alongside other options that are safe for the person's individual circumstances. 808:

therapies fail to manage cuffitis and the person either is not suitable for or does not want to undergo a revision operation to remove the retained cuff and hand sew the pouch on the level of the dentate line (spot where anal skin changes to rectal mucus layer).

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The surgical evolution of the anal pouch also empowered people who were forced to lose their colon and rectum because of disease with choice: they could decide to live their life with an ileostomy or undergo reconstructive surgery to restore anal evacuation.

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Gorgun, E.; Cengiz, T. B.; Aytac, E.; Aiello, A.; Da Silva, G.; Goldberg, J. M.; Holubar, S. D.; Stocchi, L.; Wexner, S. D.; Steele, S. R.; Hull, T. L. (2019). "Does laparoscopic ileal pouch-anal anastomosis reduce infertility compared with open approach?".

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Kameyama, Hitoshi; Hashimoto, Yoshifumi; Shimada, Yoshifumi; Yamada, Saki; Yagi, Ryoma; Tajima, Yosuke; Okamura, Takuma; Nakano, Masato; Miura, Kohei; Nagahashi, Masayuki; Sakata, Jun; Kobayashi, Takashi; Kosugi, Shin-ichi; Wakai, Toshifumi (April 2018).

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premiered the W-pouch which was an augmentation of the J-pouch made to expand the pouch's capacity and reduce the person's frequency of bowel movements. Nicholls' W-pouch is explained as two J-pouches placed together to make the higher capacity W-pouch.

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Lightner, A. L.; Shogan, B. D.; Mathis, K. L.; Larson, D. W.; Duchalais, E.; Pemberton, J. H.; Dozois, E. J. (2018). "Revisional and Reconstructive Surgery for Failing IPAA is Associated with Good Function and Pouch Salvage in Highly Selected Patients".

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Richard, Mathias L.; Liguori, Giuseppina; Lamas, Bruno; Brandi, Giovanni; da Costa, Gregory; Hoffmann, Thomas W.; Pierluigi Di Simone, Massimo; Calabrese, Carlo; Poggioli, Gilberto; Langella, Philippe; Campieri, Massimo; Sokol, Harry (12 October 2017).

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Just as debate continues on which formation of pouch functions best, there is also an ongoing discussion about the pouch's type of anal anastomosis - or method used to attach the pouch to the anal canal. Both methods have risks and benefits.

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Standard guidelines for J-pouch construction is to use two loops of 15–20 cm ileum. If the pouch is too small, the pouch will have a small volume. This will increase the frequency of moments and could also be a cause of pouch failure.

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If a colectomy is planned, and not done as an emergency due to severe injury or illness and the person is in good health, some surgeons will recommend a two-step procedure. When done as a two-step, the first operation (step one) involves a

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anus' opening, can be treated with creams, by using a squirt water bottle or hand bidet after each movement to wash away enzymes, or by placing a piece of gauze between buttocks to prevent seepage from irritating the skin around the anus.

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Anastomotic leaks occur on the lines where the pouch was sutured or stapled. They usually occur close to the time of surgery but can appear months or years later. When an anastomotic leak occurs, it can form a fistula or tract of fluid.

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Remzi, F. H.; Aytac, E.; Ashburn, J.; Gu, J.; Hull, T. L.; Dietz, D. W.; Stocchi, L.; Church, J. M.; Shen, B. (2015). "Transabdominal Redo Ileal Pouch Surgery for Failed Restorative Proctocolectomy: Lessons Learned over 500 Patients".

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Holubar, S. D.; Neary, P.; Aiello, A.; Shawki, S.; Delaney, C. P.; Steele, S. R.; Hull, T.; Stocchi, L. (2019). "Ileal pouch revision vs excision: Short-term (30-day) outcomes from the National Surgical Quality Improvement Program".

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Shehab, Mohammad; Alrashed, Fatema; Charabaty, Aline; Bessissow, Talat (2021). "Biologic Therapies for the Treatment of Post Ileal Pouch Anal Anastomosis Surgery Chronic Inflammatory Disorders: Systematic Review and Meta-analysis".

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is a hand-sewn formation consisting of three 15 cm limbs of terminal ileum to construct the S-shaped pouch with a with a 2 cm exit conduit at the bottom. The S-pouch was the first pouch formation originally premiered by

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The W-pouch was entirely hand-sewn and required a very experienced and highly skilled surgeon plus more time in the operating room. A J-pouch was not as technical and therefore, more surgeons could perform the procedure.

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Selvaggi, F.; Giuliani, A.; Gallo, C.; Signoriello, G.; Riegler, G.; Canonico, S. (2000). "Randomized, controlled trial to compare the J-pouch and W-pouch configurations for ulcerative colitis in the maturation period".

1065:

rectum, or near the J-pouch, is a serious complication. It can occur due to several reasons. But sometimes when pouchitis is not treated well, it gradually weakens the intestinal wall, which can eventually perforate.

802:

First-line therapy for acute cuffitis due to retained rectal mucosal layer is usually similar to the treatment for ulcerative proctosis that ulcerative colitis patients would have likely used before pouch surgery.

2829:

Hermanson, M.; Bengtson, J.; Croix, H.; Lindholm, E.; Block, M. (2022). "Ileal pouch-anal anastomosis; 18 years of experience and outcomes across two generations of surgeons at a tertiary center in Sweden".

653:

which is the transitional line between anal canal skin and colorectal mucosal layer. It is technically more demanding for a surgeon to perform a hand sewn anal anastomosis than a stapled anal anastomosis.

442:

By the early 1980s, the ileal pouch procedure had become part of specialist colorectal surgical practices not just in the United Kingdom and United States but worldwide. Following the unexpected death of

4439:

McCurdy, J. D.; Loftus Jr, E. V.; Tremaine, W. J.; Smyrk, T. C.; Bruining, D. H.; Pardi, D. S.; Raffals, L. E.; Kisiel, J. B.; Coelho-Prabhu, N.; Kane, S. V.; Faubion, W. A.; Papadakis, K. A. (2013).

4347:

McCurdy, J. D.; Loftus Jr, E. V.; Tremaine, W. J.; Smyrk, T. C.; Bruining, D. H.; Pardi, D. S.; Raffals, L. E.; Kisiel, J. B.; Coelho-Prabhu, N.; Kane, S. V.; Faubion, W. A.; Papadakis, K. A. (2013).

145:

in Sweden during 1969. It was an evolution in bowel surgery because it created an ileum pouch for storage of waste inside the body eliminating the need for an external bag for waste collection. An

4153:

Tyler, Andrea D.; Murdoch, Travis B.; Riddell, Robert H.; Cohen, Zane; Silverberg, Mark S. (20 July 2011). "Celiac disease detected by pouch biopsy of a patient with ileal pouch-anal anastomosis".

3155: 2901: 964:

after the pouch is already in use. With symptoms for pouch prolapse, a person typically has evacuation difficulties, seepage, pain, nausea, abdominal pain, or overt external prolapse of tissue.

616:

and other complications including infection), or when the patient is extremely ill, the colectomy and pouch construction are performed in separate stages, resulting in a three-part surgery.

427:'s prestigious pouch practice in 1983 when the clinic performed its first pouch surgery. In 2002 the Cleveland Clinic opened the world's first pouch center with its "Ileal Pouch Center". 6171: 4913:

Koh, P. K.; Doumit, J.; Downs-Kelly, E.; Bronner, M. P.; Salimi, R.; Fazio, V. W.; Vogel, J. D. (20 December 2008). "Ileo-anal j-pouch cancer: an unusual case in an unusual location".

87:

in cases where the colon and rectum have been removed. The pouch retains and restores functionality of the anus, with stools passed under voluntary control of the person, preventing

6232: 928:

A pelvic collection or collection of fluid anywhere from a leak is called a sinus. When an anastomotic leak is not treated promptly or does not heal it can cause pelvic sepsis.

2102:

Ravitch, M. M.; Sabiston, D. C. (June 1947). "Anal ileostomy with preservation of the sphincter; a proposed operation in patients requiring total colectomy for benign lesions".

5073:"Two-time perforation of the ileal J-pouch 6 and 18 years after restorative proctocolectomy and ileal pouch–anal anastomosis for familial adenomatous polyposis: a case report" 2505: 560:

S-pouch design was eventually advanced to remove the conduit since it was determined that the conduit caused some people with S-pouches, but not all, evacuation difficulties.

1213:

can all cause dehydration. Having an episode of pouchitis, or pouch inflammation, can also cause dehydration for some if the episode causes an increase in bowel movements.

315:

Pouch surgery comes with a number of well known complications that a person will not be able to imagine as possibilities themselves, therefore, as part of the education and

2997:"Three-stage Laparoscopic Ileal Pouch-anal Anastomosis Is the Best Approach for High-risk Patients with Inflammatory Bowel Disease: An Analysis of 185 Consecutive Patients" 1742: 272:

Even after a person has their colon and rectum removed, the circumstances that created ulcerative colitis still lives on inside that person's body because it is a systemic

4821:

Senapati, A.; Tibbs, C. J.; Ritchie, J. K.; Nicholls, R. J.; Hawley, P. R. (20 July 1996). "Stenosis of the pouch anal anastomosis following restorative proctocolectomy".

1056:

can quickly become life-threateningly ill. When levels are dangerously low, medical intervention with supplementation either orally or intravenously becomes necessary.

587:

The entire procedure can be performed in one operation, but is usually split into two or three procedures based on the person's overall health at the time of surgery.

465:

living with a pouch interested in continued care, or loved ones who care for a person eligible for pouch construction surgery, or for loved ones already with a pouch.

4322: 434:

in Minnesota also started offering it to suitable patients including Roger R. Dozois who published several early studies on the pouch operation in the United States.

1293:

residency abroad. Further, in the United States, citizens and residents of the 12 states that still have not taken the Obamacare extension will not be eligible for

851:

subclass of IgG. IgG4 disease is a chronic immune-mediated fibroinflammatory disorder that can manifest with painless enlargement of organs or tumor-like masses.

3946:

Characteristics of Pouchitis Involving the Rectal Cuff in Patients with Inflammatory Bowel Disease Treated by Proctocolectomy with Ileal Pouch-Anal Anastomosis".

2143:

Utsunomiya, J.; Iwama, T.; Imajo, M.; Matsuo, S.; Sawai, S.; Yaegashi, K.; Hirayama, R. (1980). "Total colectomy, mucosal proctectomy, and ileoanal anastomosis".

6409:"United Ostomy Associations of America l Supporting, empowering, and advocating for people who have had or who will have ostomy or continent diversion surgery" 3920: 1216:

This experiences mean that people with pouches, like people with ileostomies, will require drinking more fluids and eating more salt to not become dehydrated.

323:, they should also be informed before a pouch is recommended and created that their pathology is unknown due to the even higher risk indeterminate folks face. 694:

scar tissue formation over fallopian tubes blocking ovulation, although, scar tissue formation appears to be less likely with laparoscopic than open surgery.

1758:"Treatment of rectal cuff inflammation (Cuffitis) in patients with ulcerative colitis following restorative proctocolectomy and ileal pouch-anal anastomosis" 6191: 2873: 2780:

Tekkis, P. P.; Fazio, V. W.; Lavery, I. C.; Remzi, F. H.; Senagore, A. J.; Wu, J. S.; Strong, S. A.; Poloneicki, J. D.; Hull, T. L.; Church, J. M. (2005).

106:

With an optional ileo-anal pouch procedure, the pouch component is a surgically constructed internal intestinal reservoir; usually situated near where the

4196:

Deputy, Mohammed; Segal, Jonathan; Reza, Lillian; Worley, Guy; Costello, Samuel; Burns, Elaine; Faiz, Omar; Clark, Susan; Hart, Ailsa (15 February 2021).

2448:"The effect of ageing on function and quality of life in ileal pouch patients: A single cohort experience of 409 patients with chronic ulcerative colitis" 312:

muscles or a diseased anus. The end decision should always be the patient's choice, based on if their health permits the option to have a good outcome.

842:

Typically, the first therapy approach to manage Celiac disease in person with an ileum pouch is dietary modification to reduce and/or eliminate gluten.

2532:"Update of complications and functional outcome of the ileo-pouch anal anastomosis: overview of evidence and meta-analysis of 96 observational studies" 1987: 6157: 3054:

Lovegrove, R. E.; Constantinides, V. A.; Heriot, A. G.; Athanasiou, T.; Darzi, A.; Remzi, F. H.; Nicholls, R. J.; Fazio, V. W.; Tekkis, P. P. (2006).

936:

Pelvic sepsis also called peri pouch sepsis is a main cause of pouch failure and it creates conditions that make major revisionary surgery difficult.

481:

and surgeons should also be able to refer people to pouch specialists for a second opinion on an existing recommendation or for continued pouch care.

3656:

Deputy, Mohammed; Segal, Jonathan; Reza, Lillian; Worley, Guy; Costello, Samuel; Burns, Elaine; Faiz, Omar; Clark, Susan; Hart, Ailsa (20 May 2021).

2250:"A systematic review and meta-analysis comparing adverse events and functional outcomes of different pouch designs after restorative proctocolectomy" 1251:. If a person becomes severely dehydrated, hospital admission for intravenous administration of fluids to restore hydration safely may be required. 5812:"Bowel function after J-pouch may be more complex than previously appreciated: A comprehensive analysis to highlight existing knowledge gaps - PMC" 1429: 6233:

https://www.ehealthinsurance.com/medicare/states/moving-another-state/#:~:text=You%20won't%20lose%20your,cover%20you%20in%20another%20state

4956:

Shen, Bo; Fazio, Victor W.; Remzi, Feza H.; Lashner, Bret A. (December 2005). "Clinical Approach to Diseases of Ileal Pouch-Anal Anastomosis".

1264:

meals that provide additional amounts of needed vitamins and minerals. Studies show that some foods may also contribute to pouch inflammation.

6279: 2004:

Deputy, Mohammed; Segal, Jonathan; Reza, Lillian; Worley, Guy; Costello, Samuel; Burns, Elaine; Faiz, Omar; Clark, Susan; Hart, Ailsa (2021).

1935:

Deputy, Mohammed; Segal, Jonathan; Reza, Lillian; Worley, Guy; Costello, Samuel; Burns, Elaine; Faiz, Omar; Clark, Susan; Hart, Ailsa (2021).

1880: 541:

is two 15 to 20 cm sections of the small intestine formed into a J-shaped pouch in order to replace the function of the rectum and store

276:

condition. These conditions occasionally manifest in other ways including additional illnesses considered related to ulcerative colitis like

6059:"Bowel function after J-pouch may be more complex than previously appreciated: A comprehensive analysis to highlight existing knowledge gaps" 5338: 4774:

Joyce, Myles R.; Fazio, Victor W.; Hull, Tracy T.; Church, James; Kiran, Ravi P.; Mor, Isabella; Lian, Lei; Shen, Bo; Remzi, Feza H. (2010).

2979: 2686: 2595: 273: 261: 1615:

Panis, Y.; Poupard, B.; Hautefeuille, P.; Valleur, P.; Nemeth, J.; Lavergne, A. (1996). "Ileal pouch/Anal anastomosis for Crohn's disease".

1572:

Panis, Y.; Poupard, B.; Nemeth, J.; Lavergne, A.; Hautefeuille, P.; Valleur, P. (1996). "Ileal pouch/Anal anastomosis for Crohn's disease".

381:

in 1969 because Parks' ileum pouch-anal anastomosis (IPAA), unlike Kock's 'continent ileostomy' allowed for restoration of anal evacuation.

3386: 3272: 3056:"A Comparison of Hand-Sewn Versus Stapled Ileal Pouch Anal Anastomosis (IPAA) Following Proctocolectomy: A Meta-Analysis of 4183 Patients" 319:

process before pouch creation surgery is scheduled, risks, complications, and safe alternatives need to be communicated. If a person has

2530:

de Zeeuw, Sharonne; Ali, Usama Ahmed; Donders, Rogier A. R. T.; Hueting, Willem E.; Keus, Frederik; van Laarhoven, Cees J. H. M. (2012).

365:

also in London where they continued to develop the intestinal pouch procedure. The pair first published details of the procedure in the

238:, reconstructive surgeries are not medically necessary, meaning they are elective operations. Several words can be used to describe an ' 491: 1756:

Shen, B.; Lashner, B. A.; Bennett, A. E.; Remzi, F. H.; Brzezinski, A.; Achkar, J. P.; Bast, J.; Bambrick, M. L.; Fazio, V. W. (2004).

1165:(UC) flare, for people who got their pouch as a result of UC. People with a small volume pouch will likely experience more movements. 545:

until it can be eliminated. J-pouches can either be hand sewn or stapled. Most J-pouches today are constructed using linear staplers.

4999: 3569:"Review article: restorative proctocolectomy, indications, management of complications and follow-up--a guide for gastroenterologists" 876: 861: 755: 6205: 4864:

Quinn, Kevin P.; Tse, Chung Sang; Lightner, Amy L.; Pendegraft, Richard S.; Enders, Felicity T.; Raffals, Laura E. (20 August 2017).

1341: 6549: 5276: 2495: 1817: 166:

surgically removed due to disease, injury, or infection. Several diseases and conditions may trigger the need for surgical removal.

5300: 4006:

Tulchinsky, H.; McCourtney, J. S.; Rao, K. V.; Chambers, W.; Williams, J.; Wilkinson, K. H.; Nicholls, R. J. (20 December 2001).

2902:"British Journal of Nursing - Nurse-led surveillance of ileoanal pouch patients post-stoma reversal: Outcomes at 12-month review" 5131: 4662:

Borejsza-Wysocki, M.; Szmyt, K.; Bobkiewicz, A.; Malinger, S.; Świrkowicz, J.; Hermann, J.; Drews, M.; Banasiewicz, T. (2015).

4057:"Clinical course of cuffitis in ulcerative colitis patients with restorative proctocolectomy and ileal pouch-anal anastomoses" 4008:"Salvage abdominal surgery in patients with a retained rectal stump after restorative proctocolectomy and stapled anastomosis" 3175:"Salvage abdominal surgery in patients with a retained rectal stump after restorative proctocolectomy and stapled anastomosis" 6012:"Water and electrolyte balance after ileal J pouch-anal anastomosis in ulcerative colitis and familial adenomatous polyposis" 3036: 569:

is a hand-sewn pouch formation constructed using four loops of 12 cm length terminal ileum. The W-pouch was created by

277: 250: 187: 430:

About the same time as the Cleveland Clinic began offering the restorative proctocolectomy procedure (RPC), surgeons at the

3616:

Holubar, Stefan D. (May 2018). "Prevention, Diagnosis, and Treatment of Complications of the IPAA for Ulcerative Colitis".

3498: 1260:

or medical interventions like fiber products or doctor prescribed tablets to control watery stool and prevent dehydration.

1317: 600:(removal of the large intestine and rectum), and fashioning of the pouch. The patient is given a temporary defunctioning 3883:"Restorative proctocolectomy with J-pouch, ileoanal stapled anastomosis, and preservation of the anal canal in children" 995:

examples: irritable pouch syndrome, pelvic floor dysfunction, evacuation difficulties, coexisting psychiatric diagnosis

6192:"3.7 Million People Would Gain Health Coverage in 2023 if the Remaining 12 States Were to Expand Medicaid Eligibility" 5016:"Small Bowel Obstruction After Ileal Pouch-Anal Anastomosis With a Loop Ileostomy in Patients With Ulcerative Colitis" 1152:

ileostomy after disease removal. Pouches are the individual's choice based on how a person wants to live their life.

423:

was a driving force behind the procedure's adaptation into American colorectal surgery offerings. He established the

6480:

Bach, Simon P; Mortensen, Neil J. M (February 2006). "Revolution and evolution: 30 years of ileoanal pouch surgery".

3173:

Tulchinsky, H.; McCourtney, J. S.; Rao, K. V.; Chambers, W.; Williams, J.; Wilkinson, K. H.; Nicholls, R. J. (2001).

1122:

People can also choose to convert their failed ileo pouch-anal anastomosis (IPAA) to a continent ileostomy such as a

5071:

Shibata, Kengo; Ebinuma, Shota; Sakamoto, Sodai; Suzuki, Asami; Terasaki, Yasunobu; Taketomi, Akinobu (2022-01-04).

2711:"British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults" 1537:

Joyce, Myles R.; Fazio, Victor W. (September 2009). "Can Ileal Pouch Anal Anastomosis Be Used in Crohn's Disease?".

5876: 1297:

if they become seriously unwell in certain circumstances including if they are unmarried and do not have children.

875:

Biopsies of the pouch should confirm if an infection is the root cause of pouch inflammation. If an infection from

780:

healing may lag behind symptomatic improvement, mucosal healing is a treatment target for patients with pouchitis.

666:

Stapled anal anastomosis' are considered easier to perform than hand sewn which typically take more time and skill.

6057:

Lee, G. C.; Cavallaro, P. M.; Savitt, L. R.; Hodin, R. A.; Kunitake, H.; Ricciardi, R.; Bordeianou, L. G. (2020).

5862: 5810:

Lee, G. C.; Cavallaro, P. M.; Savitt, L. R.; Hodin, R. A.; Kunitake, H.; Ricciardi, R.; Bordeianou, L. G. (2020).

6554: 5672:"An Alternative Conversion Technique for Salvaging a Failed Ileal J-Pouch-Anal Anastomosis to a Modified H-Pouch" 5670:

Araki, Toshimitsu; Miki, Chikao; Yoshiyama, Shigeyuki; Ohkita, Yoshiki; Yasuda, Hiromi; Kusunoki, Masato (2007).

1332: 2710: 3780:"Efficacy of Vedolizumab for Refractory Pouchitis of the Ileo-anal Pouch: Results From a Multicenter US Cohort" 1286: 1236: 1210: 5996: 3759: 4396:

Seril, Darren N.; Shen, Bo (20 July 2014). "Clostridium difficile infection in patients with ileal pouches".

769:

classified into subgroups. It is possible to have one or more causes of pouch inflammation at the same time.

765:(CMV). Treatment of infections usually begins with antibiotics and may also include multi-strain probiotics. 357:

pouch surgery. Shortly after performing the world's first few pouch procedures in 1976, Sir Alan along with

1232:. People may also notice that urine has changed from light yellow and become darker and more concentrated. 570: 448: 403: 358: 127: 6259: 4564:"Endoscopic closure instead of surgery to close an ileal pouch fistula with the over-the-scope clip system" 2248:

Simillis, C.; Afxentiou, T.; Pellino, G.; Kontovounisios, C.; Rasheed, S.; Faiz, O.; Tekkis, P. P. (2018).

6219: 5472: 301: 231: 5892:"Nonrelaxing Pelvic Floor Dysfunction is an Underestimated Complication of Ileal Pouch-Anal Anastomosis" 4866:"Nonrelaxing Pelvic Floor Dysfunction Is an Underestimated Complication of Ileal Pouch-Anal Anastomosis" 1360: 704: 345: 320: 209: 119: 4487: 2129: 574: 452: 362: 123: 4055:

Wu, Bin; Lian, Lei; Li, Yue; Remzi, Feza H.; Liu, Xiuli; Kiran, Ravi P.; Shen, Bo (20 February 2013).

2446:

Hahnloser, D.; Pemberton, J. H.; Wolff, B. G.; Larson, D. R.; Crownhart, B. S.; Dozois, R. R. (2004).

6260:"How to Get a Pre-Existing Medical Condition Exclusion Waiver with Travel Insurance – Forbes Advisor" 4542: 1102: 150:

removal. It should be the patient's optional choice based on how a person wants to live their life.

5890:

Quinn, K. P.; Tse, C. S.; Lightner, A. L.; Pendegraft, R. S.; Enders, F. T.; Raffals, L. E. (2017).

4245: 1660:"When Not to Pouch: Important Considerations for Patient Selection for Ileal Pouch–Anal Anastomosis" 2186:

Utsunomiya, J.; Yamamura, T.; Kusunoki, M.; Natori, H.; Fujimoto, Y.; Shoji, Y.; Iwama, T. (1989).

420: 2397:

Taylor, B. M.; Cranley, B.; Kelly, K. A.; Phillips, S. F.; Beart Jr, R. W.; Dozois, R. R. (1983).

1189:. However, people with an ileum pouch have lost their entire colon and at least small amounts of 6505: 6468: 6039: 5978: 5921: 5792: 5748: 5701: 5652: 5603: 5542: 5492: 5450: 5344: 5282: 5241: 5197: 4981: 4938: 4895: 4846: 4803: 4421: 4227: 4178: 4135: 4086: 4037: 3963: 3902: 3687: 3598: 3567:

McLaughlin, S. D.; Clark, S. K.; Tekkis, P. P.; Ciclitira, P. J.; Nicholls, R. J. (20 May 2008).

3466: 3408: 3367: 3326: 3253: 3204: 3137: 2855: 2692: 2601: 2323: 2279: 2168: 2035: 1966: 1785: 1724: 1640: 1597: 1519: 1162: 512: 466: 265: 257: 246: 175: 88: 6280:"Travel insurance if you have a pre-existing medical condition or disability | MoneyHelper" 5259:

Keller, Deborah S.; Kiran, P. Ravi (2019). "Salvage and Revision Surgery for the Failed Pouch".

205: 181: 6497: 6460: 6139: 6088: 6031: 5970: 5913: 5841: 5784: 5740: 5693: 5644: 5595: 5534: 5442: 5398: 5334: 5272: 5233: 5189: 5153: 5112: 5094: 5053: 5035: 4973: 4930: 4887: 4838: 4795: 4775: 4745: 4693: 4644: 4595: 4547: 4522: 4470: 4413: 4378: 4349:"Cytomegalovirus Infection of the Ileoanal Pouch: Clinical Characteristics and Outcomes - PMC" 4304: 4219: 4170: 4127: 4078: 4029: 3863: 3809: 3738: 3679: 3633: 3590: 3549: 3458: 3318: 3245: 3196: 3129: 3085: 3018: 2995:

Mège, D.; Figueiredo, M. N.; Manceau, G.; Maggiori, L.; Bouhnik, Y.; Panis, Y. (August 2016).

2975: 2950: 2847: 2811: 2762: 2682: 2651: 2591: 2561: 2477: 2428: 2379: 2315: 2271: 2230: 2199: 2160: 2111: 2084: 2027: 1958: 1917: 1862: 1777: 1716: 1699:

Cohen, Zane; Smith, David; McLeod, Robin (1998). "Reconstructive Surgery for Pelvic Pouches".

1681: 1632: 1589: 1554: 1511: 1470: 1411: 1225: 1206: 6106:

Ianco, O.; Tulchinsky, H.; Lusthaus, M.; Ofer, A.; Santo, E.; Vaisman, N.; Dotan, I. (2013).

4668:

Wideochirurgia I Inne Techniki Maloinwazyjne = Videosurgery and Other Miniinvasive Techniques

4664:"Endoscopic vacuum-assisted closure system (E-VAC): Case report and review of the literature" 402:

The same year as Sir Alan Parks' unexpected death in 1982, his St Mark's Hospital colleague,

6489: 6450: 6129: 6119: 6078: 6070: 6023: 5960: 5952: 5903: 5831: 5823: 5776: 5732: 5683: 5634: 5587: 5526: 5484: 5432: 5388: 5380: 5326: 5264: 5225: 5181: 5143: 5130:

Panwar, Rajesh; Khan, Arif Ali; Pal, Sujoy; Dash, Nihar Ranjan; Ahuja, Vineet (2017-06-01).

5102: 5084: 5043: 5027: 4965: 4922: 4877: 4830: 4787: 4735: 4727: 4683: 4675: 4634: 4626: 4585: 4575: 4512: 4460: 4452: 4405: 4368: 4360: 4294: 4286: 4209: 4162: 4117: 4068: 4019: 3955: 3894: 3853: 3845: 3799: 3791: 3728: 3718: 3669: 3625: 3580: 3539: 3531: 3450: 3398: 3357: 3310: 3235: 3186: 3119: 3075: 3067: 3008: 2940: 2932: 2839: 2801: 2793: 2752: 2674: 2641: 2633: 2583: 2551: 2543: 2467: 2459: 2418: 2410: 2369: 2361: 2307: 2261: 2152: 2074: 2066: 2017: 1948: 1907: 1852: 1844: 1769: 1708: 1671: 1624: 1581: 1546: 1501: 1460: 1401: 1393: 1282: 1278: 1173:

causing avoidable complications like incisional hernias after reversal or takedown surgery.

478: 424: 316: 239: 5562: 5320: 340:

The surgical procedure for forming an ileal pouch-anal anastomosis (IPAA) was pioneered by

4762: 3425: 2399:"A clinico-physiological comparison of ileal pouch-anal and straight ileoanal anastomoses" 1186: 882: 868: 832: 762: 613: 597: 524: 198: 159: 84: 6245: 5941:"Biofeedback in patients with ileoanal pouch dysfunction: A specialist centre experience" 5576:"The usefulness of the H-pouch configuration in salvage surgery for failed ileal pouches" 5575: 5515:"The usefulness of the H-pouch configuration in salvage surgery for failed ileal pouches" 5419:

Tekkis, P. P.; Heriot, A. G.; Smith, J. J.; Das, P.; Canero, A.; Nicholls, R. J. (2006).

776:

include metronidazole 500 mg (twice daily) or tinidazole 500 mg (twice daily).

4501:"Perianal Fistulas in Patients with Crohn's Disease, Part 1: Current Medical Management" 4441:"Cytomegalovirus Infection of the Ileoanal Pouch: Clinical Characteristics and Outcomes" 6493: 6134: 6107: 6083: 6058: 5836: 5811: 5393: 5368: 5268: 5107: 5072: 5048: 5015: 4740: 4715: 4688: 4663: 4639: 4614: 4590: 4563: 4517: 4500: 4465: 4440: 4373: 4348: 4299: 4274: 3882: 3858: 3833: 3804: 3779: 3733: 3706: 3544: 3519: 3503: 3080: 3071: 3055: 2945: 2920: 2806: 2797: 2781: 2646: 2621: 2556: 2531: 2472: 2463: 2447: 2423: 2398: 2374: 2349: 2079: 2054: 1912: 1895: 1857: 1676: 1659: 1465: 1448: 1406: 1381: 1274: 1248: 974: 650: 556: 470: 341: 5421:"Long-term results of abdominal salvage surgery following restorative proctocolectomy" 4198:"The pouch behaving badly: management of morbidity after ileal pouch–anal anastomosis" 3658:"The pouch behaving badly: management of morbidity after ileal pouch-anal anastomosis" 2006:"The pouch behaving badly: Management of morbidity after ileal pouch–anal anastomosis" 1937:"The pouch behaving badly: Management of morbidity after ileal pouch–anal anastomosis" 1628: 1585: 737:

examples: pouchitis, cuffitis, Crohn's disease of the pouch, Celiac disease, IgG, IgG4

6543: 4969: 4290: 4231: 4024: 4007: 3967: 3691: 3585: 3568: 3412: 3371: 3330: 3240: 3223: 3191: 3174: 2971:

Sabiston Textbook of Surgery E-Book: The Biological Basis of Modern Surgical Practice

2859: 2414: 2039: 1970: 1773: 1244: 1019:

got their pouch as a result of bowel cancer may also experience cancer of the pouch.

945:

examples: large or small pouch, U-bends, twists, prolapse, stricture, weak sphincters

885:(CMV) is found, initial therapy is usually antibiotics. Certain infections such as a 369:

in 1978 with the article "Proctocolectomy without ileostomy for ulcerative colitis".

305: 235: 100: 6509: 5939:

Segal, J. P.; Chan, H.; Collins, B.; Faiz, O. D.; Clark, S. K.; Hart, A. L. (2018).

5796: 5752: 5656: 5607: 5546: 5496: 5454: 5348: 5286: 5245: 5201: 4985: 4942: 4850: 4807: 4425: 4182: 4090: 4041: 3921:"BSG consensus guidelines on the management of Inflammatory Bowel Disease in adults" 3906: 3602: 3470: 3257: 3208: 3141: 2696: 2327: 2172: 1789: 1728: 1644: 1601: 1523: 6472: 6043: 5982: 5925: 5705: 4899: 4139: 2605: 2283: 1028:

examples: malnutrition, anemia, vitamin B12 and vitamin D deficiency, low potassium

662: 300:

A pouch should never be offered as the only treatment option due to the fact it is

193: 6534: 5956: 4615:"Computed tomography-guided endoscopic needle knife therapy for ileal pouch sinus" 3124: 3107: 2843: 2637: 1506: 1489: 6172:"Twelve States Have Yet to Pass a Medicaid Expansion—Nine Are Run by Republicans" 6074: 5827: 5671: 5369:"Technical aspects of ileoanal pouch surgery in patients with ulcerative colitis" 5229: 5185: 4716:"Technical aspects of ileoanal pouch surgery in patients with ulcerative colitis" 4456: 4364: 4122: 4105: 4073: 4056: 3959: 3629: 3535: 3403: 2921:"Technical Aspects of Ileoanal Pouch Surgery in Patients with Ulcerative Colitis" 2350:"Technical Aspects of Ileoanal Pouch Surgery in Patients with Ulcerative Colitis" 103:

or stoma appliance, to collect waste which can be emptied and changed as needed.

6529: 5623:"Modified H-pouch as an alternative to the J-pouch for anorectal reconstruction" 3346:"Age-discriminated IVF Access and Evidence-based Ageism: Is There a Better Way?" 1217: 1049: 1037: 542: 431: 122:

since 1990). After the first surgery, he continued to develop the procedure at

72: 6206:"Can you get health insurance with pre-existing conditions? | money.co.uk" 5488: 5089: 4273:

Aschermann, S.; Lux, A.; Baerenwaldt, A.; Biburger, M.; Nimmerjahn, F. (2010).

3314: 3224:"Fertility after ileal pouch-anal anastomosis in women with ulcerative colitis" 1550: 1036:

The importance of ileum is that it absorbs key vitamins and minerals including

676:

the rectum, if any, can be safely managed until removal during pouch creation.

6010:

Okamoto, T.; Kusunoki, M.; Kusuhara, K.; Yamamura, T.; Utsunomiya, J. (1995).

5908: 5891: 5330: 4926: 4882: 4865: 4791: 3362: 3345: 3013: 2996: 2757: 2740: 2678: 2587: 2547: 1123: 804: 628: 520: 474: 444: 374: 138: 115: 80: 6366:"Pouch support charity | Red Lion Group | UK Pouch Support Charity" 6124: 5098: 5039: 4679: 3723: 685:

counselling as part of their patient selection and informed consent process.

627:) first, since removal of the rectum can lead to complications with the anal 477:

should be able to communicate their pouch surgery success and failure rates.

5940: 5720: 5514: 4630: 3438: 1757: 1221: 1045: 1041: 789:

the anal canal, a change in bowel movements, and sometimes rectal bleeding.

601: 378: 309: 285: 146: 142: 92: 6501: 6464: 6143: 6092: 6011: 5974: 5965: 5917: 5845: 5788: 5744: 5697: 5648: 5599: 5538: 5446: 5402: 5384: 5237: 5193: 5157: 5116: 5057: 4977: 4934: 4891: 4799: 4749: 4731: 4697: 4648: 4599: 4526: 4474: 4417: 4382: 4308: 4223: 4174: 4131: 4082: 4033: 3867: 3813: 3742: 3683: 3637: 3594: 3553: 3462: 3322: 3249: 3200: 3133: 3089: 3022: 2954: 2936: 2851: 2815: 2766: 2655: 2565: 2481: 2383: 2365: 2319: 2275: 2218: 2187: 2115: 2031: 1962: 1921: 1866: 1781: 1685: 1558: 1515: 1474: 1161:

The number of movements per day may seem similar to when someone was in an

6108:"Diet of patients after pouch surgery may affect pouch inflammation - PMC" 6035: 5721:"Conversion of failed ileal pouch-anal anastomosis to continent ileostomy" 5031: 4842: 4580: 3849: 2782:"Evaluation of the Learning Curve in Ileal Pouch–Anal Anastomosis Surgery" 2496:"Toronto surgeon who helped to treat Rob Ford retires from operating room" 2432: 2234: 2203: 2164: 2070: 1720: 1712: 1636: 1593: 1397: 3795: 2500: 2088: 1415: 1294: 1202: 1198: 1194: 110:

would normally be. It is formed by folding loops of small intestine (the

20: 6523: 4409: 4323:"IgG4-Related Disease - Musculoskeletal and Connective Tissue Disorders" 4166: 1848: 1832: 6027: 5780: 5736: 5639: 5622: 5591: 5530: 5508: 5506: 5362: 5360: 5358: 4834: 4499:

Gold, S. L.; Cohen-Mekelburg, S.; Schneider, Y.; Steinlauf, A. (2018).

4214: 4197: 3898: 3674: 3657: 3520:"Geographies of generation: Age restrictions in international adoption" 2311: 2266: 2249: 2156: 2022: 2005: 1953: 1936: 1229: 1185:

Water and salts are typically reabsorbed into the body by the colon or

281: 6294:"Empowering people living with Crohn's disease and ulcerative colitis" 5688: 4275:"The other side of immunoglobulin G: suppressor of inflammation - PMC" 3454: 234:. Reconstructive procedures do not cure disease. Since they are not 6455: 6438: 6264: 6176: 5437: 5420: 4104:

Lightner, Amy L.; Pemberton, John H.; Loftus, Edward J. (June 2016).

2622:"Mucosa-associated microbiota dysbiosis in colitis associated cancer" 1988:"Stanford scientists link ulcerative colitis to missing gut microbes" 624: 528: 163: 107: 16:

Surgically created intestinal reservoir that restores anal evacuation

4488:

https://www.gastrojournal.org/article/S0016-5085(17)30136-1/fulltext

1881:"Informed Consent: The Difference Between Medical Care, and Battery" 902:

The pouch surgery itself can be the reason for some complications.

612:

When a colectomy is performed as an emergency (which can arise from

6293: 6246:"Life Insurance: What It is, How It Works, and How to Buy a Policy" 5148: 2518: 619:

Outside of serious illness, some surgeons also prefer to perform a

351: 1190: 977:

to manage chronic stenosis that keeps returning after dilatation.

516: 111: 76: 5301:"IPAA Surgical Revision: Lessons Learned from > 500 Patients" 1240: 158:

Ileo-anal pouches are constructed for people who have had their

6408: 6390: 5473:"Reprint of: Redo Ileal Pouch Surgery—Indications and Outcomes" 3222:

Olsen, K. O.; Joelsson, M.; Laurberg, S.; Oresland, T. (1999).

1326:

German Crohn's Disease and Ulcerative Colitis Society - Germany

91:

and serving as an alternative to a total proctocolectomy with

6437:

McGuire, B B; Brannigan, A E; O'Connell, P R (15 June 2007).

5319:

Warusavitarne, Janindra; Perry-Woodford, Zarah, eds. (2019).

3834:"Ulcerative Colitis: Complications of Ileoanal Pouches - PMC" 2669:

Warusavitarne, Janindra; Perry-Woodford, Zarah, eds. (2019).

6365: 4776:"Ileal Pouch Prolapse: Prevalence, Management, and Outcomes" 1273:

person has an intestinal pouch it may be harder to purchase

6353: 5414: 5412: 3273:"Fertility and Delivery After Ileal Pouch Anal Anastomosis" 898:

examples: anastomotic leaks, fistulas, sinus, pelvic sepsis

352:

Parks' S-Pouch premieres as first anal-pouch reconstruction

3101: 3099: 2055:"Proctocolectomy without ileostomy for ulcerative colitis" 1382:"Proctocolectomy without ileostomy for ulcerative colitis" 1235:

It is important that people with pouches maintain healthy

5574:

Aydinli, H. H.; Peirce, C.; Aytac, E.; Remzi, F. (2017).

5513:

Aydinli, H. H.; Peirce, C.; Aytac, E.; Remzi, F. (2017).

3108:"Ulcerative colitis - surgical indications and treatment" 2343: 2341: 2339: 2337: 1490:"Ulcerative colitis - surgical indications and treatment" 1449:"The Kock Pouch: A Continent Ileostomy With No Appliance" 1285:

including private insurance upgrades in a country with a

419:

In the United States, Australian born colorectal surgeon

213:

possibly the rectum, does not eliminate Crohn's disease.

5621:

Farinella, E.; Buggenhout, A.; Van De Stadt, J. (2014).

5563:

https://academic.oup.com/ecco-jcc/article/9/7/548/467843

137:

A similar ileal pouch without the anal anastomosis is a

6342: 4763:

https://academic.oup.com/gastro/article/6/4/246/5048415

4246:"Diagnosis and Management of IgG4-associated Pouchitis" 3981: 3707:"Inflammatory pouch disease: The spectrum of pouchitis" 3426:

https://academic.oup.com/humupd/article/11/3/261/759255

986:

create the 'J' but instead retains the shape of a 'U'.

154:

Reasons for ileal-pouch anal anastomosis (IPAA) surgery

6318: 5314: 5312: 5310: 1818:"What does an Ileal pouch or J-pouch surgery involve?" 1118:

Salvage surgery converting an anal pouch to Kock pouch

1069:

Revision, redo, salvage surgery for IPAA pouch failure

5466: 5464: 1430:"6.-St-Marks-Hospital-Pouch-Patient-Pathway-2000px-1" 847:

Other inflammatory conditions including IgG and IgG4:

456:

establishing the pouch a surgical offering in Italy.

5558: 5556: 4714:

Kirat, Hasan T.; Remzi, Feza H. (20 December 2010).

1001:

Pelvic floor dysfunction and evacuation difficulties

5877:"The Essentials of Pouch Care Nursing | Wiley" 5719:Behrens, D. T.; Paris, M.; Luttrell, J. N. (1999). 2192:

Zeitschrift für Gastroenterologie. Verhandlungsband

1831:Hall, D. E.; Prochazka, A. V.; Fink, A. S. (2012). 1243:because chronic dehydration increases the risk for 1109:

Salvage surgery to rescue a pouch by altering shape

824:encourages the desired anti-inflammatory response. 5857: 5855: 3344:Cavaliere, Giulia; Fletcher, James Rupert (2022). 1329:European Crohn's and Colitis Organisation - Europe 1087:Salvage surgery to redo an IPAA's anal anastomosis 3387:"Female age and assisted reproductive technology" 6220:"Tips for Moving to Another State with Medicare" 5997:"What is St Mark's Electrolyte Mix (Solution)?" 4613:Nyabanga, C. T.; Veniero, J.; Shen, B. (2015). 3439:"IVF is cost effective up to age 43, says NICE" 2219:"Development of ileal J-pouch anal anastomosis" 415:Adaptation of IPAA surgery in the United States 1105:) because too much small bowel would be lost. 1096:Salvage surgery to redo an entire IPAA's pouch 515:, a pouch, or intestinal reservoir, made from 327:Most common complication is pouch inflammation 5132:"Spontaneous perforation of an ileal J pouch" 3982:"Mistakes in pouchitis and how to avoid them" 1999: 1997: 680:Fertility reduction after ileum pouch surgery 377:first performed in Sweden by Finnish surgeon 226:Pouch surgery is not curative but restorative 8: 5863:"Special Concerns for People with J-Pouches" 5471:Tekkis, Paris P.; Nicholls, R. John (2018). 1048:. In medical terms, low potassium is called 671:Fertility concerns and preservation for IPAA 204:There is debate about whether patients with 6016:International Journal of Colorectal Disease 4823:International Journal of Colorectal Disease 4568:World Journal of Gastrointestinal Endoscopy 2919:Kirat, Hasan; Remzi, Feza (December 2010). 2536:International Journal of Colorectal Disease 1130:Pouch removal surgery for failed IPAA pouch 973:prescribed home dilatation routine using a 118:in 1976 at the London Hospital (called the 6535:Total proctocolectomy and ileal-anal pouch 5000:"Low Potassium Level Causes (Hypokalemia)" 3573:Alimentary Pharmacology & Therapeutics 3112:Alimentary Pharmacology & Therapeutics 2974:. Elsevier Health Sciences. p. 1336. 1896:"Complications Related to J-Pouch Surgery" 1494:Alimentary Pharmacology & Therapeutics 1338:Red Lions Group pouch support charity - UK 821:Treatment of Crohn's disease of the pouch: 723:Pouch complications and disorders for IPAA 6454: 6133: 6123: 6082: 5964: 5907: 5835: 5687: 5638: 5436: 5392: 5147: 5106: 5088: 5047: 4881: 4739: 4687: 4638: 4589: 4579: 4562:Wei, Y.; Gong, J. F.; Zhu, W. M. (2017). 4546: 4516: 4464: 4372: 4298: 4213: 4121: 4072: 4023: 3857: 3803: 3732: 3722: 3673: 3584: 3543: 3402: 3361: 3239: 3190: 3123: 3079: 3012: 2944: 2805: 2756: 2645: 2555: 2471: 2422: 2373: 2265: 2078: 2053:Parks, A G; Nicholls, R J (8 July 1978). 2021: 1952: 1911: 1856: 1833:"Informed consent for clinical treatment" 1675: 1505: 1464: 1405: 1380:Parks, A G; Nicholls, R J (8 July 1978). 1310:national organizations globally include: 1305:Support for pouch candidates and pouchees 344:at the London Hospital, today called the 5945:Scandinavian Journal of Gastroenterology 5896:Clinical Gastroenterology and Hepatology 4958:The American Journal of Gastroenterology 4870:Clinical Gastroenterology and Hepatology 4398:The American Journal of Gastroenterology 4155:The American Journal of Gastroenterology 3827: 3825: 3823: 3754: 3752: 3651: 3649: 3647: 2832:Scandinavian Journal of Gastroenterology 2188:"J-pouch: Change of a method over years" 1982: 1980: 1762:The American Journal of Gastroenterology 1268:Changes to insurance access for pouchees 230:Ileum pouch surgery (Kock and IPAA) are 4709: 4707: 4106:"Crohnʼs Disease of the Ileoanal Pouch" 3925:The British Society of Gastroenterology 3350:Science, Technology, & Human Values 1658:Chang, S.; Shen, B.; Remzi, F. (2017). 1372: 1347:The J-Pouch Group online community - US 1177:biofeedback therapy can be prescribed. 3385:Pierce, Nicole; Mocanu, Edgar (2018). 1323:Gastrointestinal (GI) Society - Canada 1060:Intestinal obstruction and perforation 280:(PSC) in the liver, the eye condition 6413:United Ostomy Associations of America 6298:Crohn’s & Colitis Australia (CCA) 714:Pouch surgery and adoption age limits 519:(small intestine) is attached to the 498:Specialized staffing at pouch centers 451:along with the pouch surgery team at 7: 5477:Seminars in Colon and Rectal Surgery 4279:Clinical and Experimental Immunology 3499:"Foreign adoption – DW – 09/22/2010" 2104:Surgery, Gynecology & Obstetrics 1837:Canadian Medical Association Journal 1350:United Ostomy Association (UOA) - US 1101:nutritional difficulties (including 511:In this elective and reconstructive 262:immune mediated inflammatory disease 5373:Clinics in Colon and Rectal Surgery 5367:Kirat, H. T.; Remzi, F. H. (2010). 5261:Pouchitis and Ileal Pouch Disorders 4780:Journal of Gastrointestinal Surgery 4720:Clinics in Colon and Rectal Surgery 3838:Clinics in Colon and Rectal Surgery 3271:Michael A. Valente; Tracy L. Hull. 2925:Clinics in Colon and Rectal Surgery 2354:Clinics in Colon and Rectal Surgery 2348:Kirat, H. T.; Remzi, F. H. (2010). 1139:Quality of life after pouch surgery 623:(removing all the colon except the 492:British Society of Gastroenterology 126:in London along with his colleague 83:, bypassing the former site of the 6494:10.1097/01.MIB.0000197547.80558.59 5269:10.1016/B978-0-12-809402-0.00037-X 4327:Merck Manuals Professional Edition 3072:10.1097/01.sla.0000225031.15405.a3 2874:"Pouch Nurse Led Clinics Protocol" 2798:10.1097/01.sla.0000152018.99541.f1 2464:10.1097/01.sla.0000141157.32234.9d 1193:. Experiences like having sudden 635:Anal anastomosis technique in IPAA 296:Alternatives to IPAA pouch surgery 14: 6112:World Journal of Gastroenterology 4505:Gastroenterology & Hepatology 3832:Gorgun, E.; Remzi, F. H. (2004). 3711:World Journal of Gastroenterology 1900:Gastroenterology & Hepatology 1664:Gastroenterology & Hepatology 773:Antibiotic therapy for pouchitis: 689:Fertility risks for men and women 6063:Diseases of the Colon and Rectum 5816:Diseases of the Colon and Rectum 5725:Diseases of the Colon and Rectum 5174:Diseases of the Colon and Rectum 4970:10.1111/j.1572-0241.2005.00278.x 4291:10.1111/j.1365-2249.2009.04081.x 4025:10.1046/j.0007-1323.2001.01931.x 3618:Diseases of the Colon and Rectum 3586:10.1111/j.1365-2036.2008.03643.x 3241:10.1046/j.1365-2168.1999.01076.x 3192:10.1046/j.0007-1323.2001.01931.x 2745:Journal of Crohn's & Colitis 2519:https://www.zanecohencentre.com/ 2508:from the original on 2022-12-05. 2415:10.1097/00000658-198310000-00006 2300:Diseases of the Colon and Rectum 2145:Diseases of the Colon and Rectum 1774:10.1111/j.1572-0241.2004.30518.x 1086: 698:Pouch surgery and IVF age limits 260:(UC), the disease is a systemic 55:, or sometimes referred to as a 6391:"Home | the J-Pouch Group" 3887:Pediatric Surgery International 3524:Social & Cultural Geography 2458:(4): 615–21, discussion 621-3. 1314:Crohn's and Colitis - Australia 1135:comes with complication risks. 1023:Systemic or metabolic disorders 264:, also often referred to as an 217:Contradictions to pouch surgery 75:of a reservoir pouch made from 6439:"Ileal pouch–anal anastomosis" 5731:(4): 490–5, discussion 495-6. 5425:The British Journal of Surgery 4012:The British Journal of Surgery 3705:Zezos, P.; Saibil, F. (2015). 3228:The British Journal of Surgery 3179:The British Journal of Surgery 3001:Journal of Crohn's and Colitis 2968:Townsend, Courtney M. (2021). 1447:Rudd, W. W. H. (August 1976). 1342:Crohn's and Colitis Foundation 1209:, or from not drinking enough 1205:in hot weather, sweating from 278:primary sclerosing cholangitis 251:familial adenomatous polyposis 188:Familial adenomatous polyposis 1: 5957:10.1080/00365521.2018.1454508 3125:10.1046/j.1365-2036.16.s4.5.x 2844:10.1080/00365521.2021.2012592 2638:10.1080/19490976.2017.1379637 1629:10.1016/S0140-6736(96)91344-6 1586:10.1016/s0140-6736(96)91344-6 1507:10.1046/j.1365-2036.16.s4.5.x 893:Surgery related complications 813:Crohn's disease of the pouch: 170:Disease, injury, or infection 6075:10.1097/DCR.0000000000001543 5828:10.1097/DCR.0000000000001543 5230:10.1097/SLA.0000000000001386 5186:10.1097/DCR.0000000000001130 4915:Techniques in Coloproctology 4457:10.1097/MIB.0b013e3182a52553 4365:10.1097/MIB.0b013e3182a52553 4123:10.1097/MIB.0000000000000712 4074:10.1097/MIB.0b013e31828100ed 3960:10.1053/j.gastro.2019.11.085 3630:10.1097/DCR.0000000000001094 3536:10.1080/14649365.2014.994669 3404:10.1097/GRH.0000000000000009 2582:. Updates in Surgery. 2019. 840:Treatment of Celiac disease: 25:ileal pouch–anal anastomosis 6482:Inflammatory Bowel Diseases 4548:10.1101/2021.05.22.21257585 4445:Inflammatory Bowel Diseases 4353:Inflammatory Bowel Diseases 4110:Inflammatory Bowel Diseases 4061:Inflammatory Bowel Diseases 3784:Inflammatory Bowel Diseases 3041:Crohnscolitisfoundation.org 2906:Britishjournalofnursing.com 1894:Freeha, K.; Bo, S. (2018). 1181:Dehydration risk with pouch 1144:the anal evacuation route. 1014:examples: adenomas, cancers 485:Gastroenterology guidelines 33:restorative proctocolectomy 6571: 6443:British Journal of Surgery 5489:10.1053/j.scrs.2018.11.016 5090:10.1186/s40792-021-01355-9 3391:Global Reproductive Health 3315:10.1016/j.surg.2019.04.045 1551:10.1016/j.yasu.2009.02.008 5909:10.1016/j.cgh.2017.02.024 5331:10.1007/978-3-319-94385-5 5136:Tropical Gastroenterology 4927:10.1007/s10151-008-0420-z 4883:10.1016/j.cgh.2017.02.024 4792:10.1007/s11605-010-1194-y 3363:10.1177/01622439211021914 2679:10.1007/978-3-319-94385-5 2588:10.1007/978-88-470-3977-3 2548:10.1007/s00384-011-1402-6 1743:"Ulcerative colitis (UC)" 1453:Canadian Family Physician 817:and other complications. 651:dentate or pectinate line 460:Specialized pouch centers 232:reconstructive procedures 79:(small intestine) to the 6550:Digestive system surgery 6530:MedlinePlus Encyclopedia 6354:https://www.ecco-ibd.eu/ 6323:Gastrointestinal Society 6125:10.3748/wjg.v19.i38.6458 5020:Annals of Coloproctology 4680:10.5114/wiitm.2015.52080 3881:Hedlund, Henrik (1994). 3724:10.3748/wjg.v21.i29.8739 3518:Leinaweaver, J. (2015). 3485:"German Adoption Lawyer" 3106:Nicholls, R. J. (2002). 2223:Nihon Geka Gakkai Zasshi 1701:World Journal of Surgery 1488:Nicholls, R. J. (2002). 1156:Bowel motions with pouch 925:Pelvic collection/sinus: 438:Global diffusion of IPAA 398:Invention of the W-pouch 389:Invention of the J-pouch 4619:Gastroenterology Report 3437:Kmietowicz, Z. (2012). 3014:10.1093/ecco-jcc/jjw040 2758:10.1093/ecco-jcc/jjx008 2739:Florian (1 June 2017). 2217:Utsunomiya, J. (1997). 1386:British Medical Journal 1126:in some circumstances. 751:Diagnosis of pouchitis: 608:Three-step IPAA surgery 507:IPAA surgical procedure 447:in 1982, his colleague 367:British Medical Journal 284:, and certain forms of 5385:10.1055/s-0030-1268250 4732:10.1055/s-0030-1268250 2937:10.1055/s-0030-1268250 2881:Stmarkshospital.nhs.uk 2366:10.1055/s-0030-1268250 1434:Stmarkshospital.nhs.uk 1287:national health system 1220:can cause feelings of 1078:IPAA repair procedures 1009:Dysplasia or neoplasia 969:Strictures or stenosis 800:Treatment of cuffitis: 732:Inflammatory disorders 573:in the early 1980s at 527:(large intestine) and 53:ileal-anal pullthrough 5077:Surgical Case Reports 5032:10.3393/ac.2017.06.14 4631:10.1093/gastro/gov026 4581:10.4253/wjge.v9.i2.95 3850:10.1055/s-2004-823070 2071:10.1136/bmj.2.6130.85 1713:10.1007/s002689900394 1398:10.1136/bmj.2.6130.85 1361:De Simone Formulation 1095: 951:Large or small pouch: 887:Clostridium difficile 878:Clostridium difficile 863:Clostridium difficile 757:Clostridium difficile 591:Two-step IPAA surgery 583:One-step IPAA surgery 346:Royal London Hospital 321:indeterminate colitis 288:throughout the body. 210:indeterminate colitis 120:Royal London Hospital 6343:https://www.dccv.de/ 5263:. pp. 455–468. 1883:. 18 September 2018. 1103:short bowel syndrome 990:Functional disorders 940:Mechanical disorders 41:ileal-anal reservoir 6158:"J-Pouch Procedure" 4410:10.1038/ajg.2014.22 4253:Practicalgastro.com 4167:10.1038/ajg.2011.91 1849:10.1503/cmaj.112120 1539:Advances in Surgery 1333:Crohn's and Colitis 1318:Crohn's and Colitis 793:Cuffitis diagnosis: 531:have been removed. 479:Gastroenterologists 475:proctology surgeons 421:Victor Warren Fazio 6028:10.1007/BF00337584 5999:. 6 November 2020. 5781:10.1111/codi.14476 5769:Colorectal Disease 5737:10.1007/BF02234174 5640:10.1111/codi.12701 5627:Colorectal Disease 5592:10.1111/codi.13788 5580:Colorectal Disease 5531:10.1111/codi.13788 5519:Colorectal Disease 5322:The Ileoanal Pouch 4835:10.1007/BF00342460 4215:10.1111/codi.15553 4202:Colorectal Disease 3899:10.1007/BF00176111 3796:10.1093/ibd/izz030 3675:10.1111/codi.15553 3662:Colorectal Disease 2671:The Ileoanal Pouch 2580:Ulcerative Colitis 2312:10.1007/BF02235573 2267:10.1111/codi.14104 2254:Colorectal Disease 2157:10.1007/BF02987076 2023:10.1111/codi.15553 2010:Colorectal Disease 1954:10.1111/codi.15553 1941:Colorectal Disease 1436:. 4 February 2022. 1163:ulcerative colitis 907:Anastomotic leaks: 621:subtotal colectomy 575:St Mark's Hospital 513:surgical procedure 363:St Mark's Hospital 258:ulcerative colitis 247:ulcerative colitis 176:Ulcerative colitis 124:St Mark's Hospital 89:fecal incontinence 6222:. 29 August 2021. 6118:(38): 6458–6464. 5689:10.1159/000105526 5676:Digestive Surgery 5340:978-3-319-94384-8 5303:. 8 October 2015. 5218:Annals of Surgery 4964:(12): 2796–2807. 4451:(11): 2394–2399. 4359:(11): 2394–2399. 4018:(12): 1602–1606. 3717:(29): 8739–8752. 3455:10.1136/bmj.e3656 3185:(12): 1602–1606. 3060:Annals of Surgery 3037:"J-Pouch Surgery" 2981:978-0-323-64064-0 2786:Annals of Surgery 2688:978-3-319-94384-8 2597:978-88-470-3976-6 2452:Annals of Surgery 2403:Annals of Surgery 1623:(9005): 854–857. 1580:(9005): 854–857. 1226:physical weakness 1207:physical exercise 453:St Marks Hospital 184:(in select cases) 31:), also known as 6562: 6555:Gastroenterology 6513: 6476: 6458: 6456:10.1002/bjs.5866 6424: 6423: 6421: 6419: 6405: 6399: 6398: 6387: 6381: 6380: 6378: 6376: 6370:Pouchsupport.org 6362: 6356: 6351: 6345: 6340: 6334: 6333: 6331: 6329: 6315: 6309: 6308: 6306: 6304: 6290: 6284: 6283: 6276: 6270: 6269: 6256: 6250: 6249: 6242: 6236: 6230: 6224: 6223: 6216: 6210: 6209: 6202: 6196: 6195: 6194:. 3 August 2022. 6188: 6182: 6181: 6168: 6162: 6161: 6154: 6148: 6147: 6137: 6127: 6103: 6097: 6096: 6086: 6054: 6048: 6047: 6007: 6001: 6000: 5993: 5987: 5986: 5968: 5936: 5930: 5929: 5911: 5902:(8): 1242–1247. 5887: 5881: 5880: 5873: 5867: 5866: 5859: 5850: 5849: 5839: 5807: 5801: 5800: 5763: 5757: 5756: 5716: 5710: 5709: 5691: 5667: 5661: 5660: 5642: 5633:(9): O332–O334. 5618: 5612: 5611: 5586:(8): e312–e315. 5571: 5565: 5560: 5551: 5550: 5525:(8): e312–e315. 5510: 5501: 5500: 5468: 5459: 5458: 5440: 5438:10.1002/bjs.5242 5416: 5407: 5406: 5396: 5364: 5353: 5352: 5316: 5305: 5304: 5297: 5291: 5290: 5256: 5250: 5249: 5212: 5206: 5205: 5168: 5162: 5161: 5151: 5127: 5121: 5120: 5110: 5092: 5068: 5062: 5061: 5051: 5010: 5004: 5003: 4996: 4990: 4989: 4953: 4947: 4946: 4910: 4904: 4903: 4885: 4876:(8): 1242–1247. 4861: 4855: 4854: 4818: 4812: 4811: 4771: 4765: 4760: 4754: 4753: 4743: 4711: 4702: 4701: 4691: 4659: 4653: 4652: 4642: 4610: 4604: 4603: 4593: 4583: 4559: 4553: 4552: 4550: 4537: 4531: 4530: 4520: 4496: 4490: 4485: 4479: 4478: 4468: 4436: 4430: 4429: 4393: 4387: 4386: 4376: 4344: 4338: 4337: 4335: 4333: 4319: 4313: 4312: 4302: 4270: 4264: 4263: 4261: 4259: 4250: 4242: 4236: 4235: 4217: 4208:(5): 1193–1204. 4193: 4187: 4186: 4161:(7): 1367–1368. 4150: 4144: 4143: 4125: 4116:(6): 1502–1508. 4101: 4095: 4094: 4076: 4052: 4046: 4045: 4027: 4003: 3997: 3996: 3994: 3992: 3978: 3972: 3971: 3948:Gastroenterology 3942: 3936: 3935: 3933: 3931: 3917: 3911: 3910: 3878: 3872: 3871: 3861: 3829: 3818: 3817: 3807: 3790:(9): 1569–1576. 3774: 3768: 3767: 3756: 3747: 3746: 3736: 3726: 3702: 3696: 3695: 3677: 3668:(5): 1193–1204. 3653: 3642: 3641: 3613: 3607: 3606: 3588: 3564: 3558: 3557: 3547: 3515: 3509: 3508: 3495: 3489: 3488: 3481: 3475: 3474: 3434: 3428: 3423: 3417: 3416: 3406: 3382: 3376: 3375: 3365: 3341: 3335: 3334: 3297: 3291: 3290: 3288: 3286: 3277: 3268: 3262: 3261: 3243: 3219: 3213: 3212: 3194: 3170: 3164: 3163: 3152: 3146: 3145: 3127: 3103: 3094: 3093: 3083: 3051: 3045: 3044: 3033: 3027: 3026: 3016: 2992: 2986: 2985: 2965: 2959: 2958: 2948: 2916: 2910: 2909: 2908:. 24 March 2022. 2898: 2892: 2891: 2889: 2887: 2878: 2870: 2864: 2863: 2826: 2820: 2819: 2809: 2777: 2771: 2770: 2760: 2735: 2729: 2728: 2726: 2724: 2715: 2707: 2701: 2700: 2666: 2660: 2659: 2649: 2616: 2610: 2609: 2576: 2570: 2569: 2559: 2527: 2521: 2516: 2510: 2509: 2492: 2486: 2485: 2475: 2443: 2437: 2436: 2426: 2394: 2388: 2387: 2377: 2345: 2332: 2331: 2294: 2288: 2287: 2269: 2245: 2239: 2238: 2214: 2208: 2207: 2183: 2177: 2176: 2140: 2134: 2133: 2126: 2120: 2119: 2110:(6): 1095–1099. 2099: 2093: 2092: 2082: 2050: 2044: 2043: 2025: 2016:(5): 1193–1204. 2001: 1992: 1991: 1990:. 28 March 2019. 1984: 1975: 1974: 1956: 1947:(5): 1193–1204. 1932: 1926: 1925: 1915: 1891: 1885: 1884: 1877: 1871: 1870: 1860: 1828: 1822: 1821: 1814: 1808: 1807: 1800: 1794: 1793: 1768:(8): 1527–1531. 1753: 1747: 1746: 1739: 1733: 1732: 1696: 1690: 1689: 1679: 1655: 1649: 1648: 1612: 1606: 1605: 1569: 1563: 1562: 1534: 1528: 1527: 1509: 1485: 1479: 1478: 1468: 1444: 1438: 1437: 1426: 1420: 1419: 1409: 1377: 1283:health insurance 1279:travel insurance 855:Pouch infections 425:Cleveland Clinic 317:informed consent 256:With regards to 240:elective surgery 6570: 6569: 6565: 6564: 6563: 6561: 6560: 6559: 6540: 6539: 6520: 6479: 6436: 6428: 6427: 6417: 6415: 6407: 6406: 6402: 6389: 6388: 6384: 6374: 6372: 6364: 6363: 6359: 6352: 6348: 6341: 6337: 6327: 6325: 6317: 6316: 6312: 6302: 6300: 6292: 6291: 6287: 6278: 6277: 6273: 6258: 6257: 6253: 6244: 6243: 6239: 6231: 6227: 6218: 6217: 6213: 6204: 6203: 6199: 6190: 6189: 6185: 6170: 6169: 6165: 6156: 6155: 6151: 6105: 6104: 6100: 6056: 6055: 6051: 6009: 6008: 6004: 5995: 5994: 5990: 5938: 5937: 5933: 5889: 5888: 5884: 5875: 5874: 5870: 5861: 5860: 5853: 5809: 5808: 5804: 5765: 5764: 5760: 5718: 5717: 5713: 5669: 5668: 5664: 5620: 5619: 5615: 5573: 5572: 5568: 5561: 5554: 5512: 5511: 5504: 5470: 5469: 5462: 5418: 5417: 5410: 5366: 5365: 5356: 5341: 5318: 5317: 5308: 5299: 5298: 5294: 5279: 5258: 5257: 5253: 5214: 5213: 5209: 5170: 5169: 5165: 5129: 5128: 5124: 5070: 5069: 5065: 5012: 5011: 5007: 4998: 4997: 4993: 4955: 4954: 4950: 4912: 4911: 4907: 4863: 4862: 4858: 4820: 4819: 4815: 4773: 4772: 4768: 4761: 4757: 4713: 4712: 4705: 4661: 4660: 4656: 4612: 4611: 4607: 4561: 4560: 4556: 4539: 4538: 4534: 4498: 4497: 4493: 4486: 4482: 4438: 4437: 4433: 4395: 4394: 4390: 4346: 4345: 4341: 4331: 4329: 4321: 4320: 4316: 4272: 4271: 4267: 4257: 4255: 4248: 4244: 4243: 4239: 4195: 4194: 4190: 4152: 4151: 4147: 4103: 4102: 4098: 4054: 4053: 4049: 4005: 4004: 4000: 3990: 3988: 3980: 3979: 3975: 3944: 3943: 3939: 3929: 3927: 3919: 3918: 3914: 3880: 3879: 3875: 3831: 3830: 3821: 3776: 3775: 3771: 3758: 3757: 3750: 3704: 3703: 3699: 3655: 3654: 3645: 3615: 3614: 3610: 3579:(10): 895–909. 3566: 3565: 3561: 3517: 3516: 3512: 3497: 3496: 3492: 3483: 3482: 3478: 3436: 3435: 3431: 3424: 3420: 3384: 3383: 3379: 3356:(5): 986–1010. 3343: 3342: 3338: 3299: 3298: 3294: 3284: 3282: 3275: 3270: 3269: 3265: 3221: 3220: 3216: 3172: 3171: 3167: 3154: 3153: 3149: 3105: 3104: 3097: 3053: 3052: 3048: 3035: 3034: 3030: 2994: 2993: 2989: 2982: 2967: 2966: 2962: 2918: 2917: 2913: 2900: 2899: 2895: 2885: 2883: 2876: 2872: 2871: 2867: 2828: 2827: 2823: 2779: 2778: 2774: 2737: 2736: 2732: 2722: 2720: 2713: 2709: 2708: 2704: 2689: 2668: 2667: 2663: 2618: 2617: 2613: 2598: 2578: 2577: 2573: 2529: 2528: 2524: 2517: 2513: 2494: 2493: 2489: 2445: 2444: 2440: 2396: 2395: 2391: 2347: 2346: 2335: 2296: 2295: 2291: 2247: 2246: 2242: 2216: 2215: 2211: 2185: 2184: 2180: 2142: 2141: 2137: 2130:"Ileal Pouches" 2128: 2127: 2123: 2101: 2100: 2096: 2065:(6130): 85–88. 2052: 2051: 2047: 2003: 2002: 1995: 1986: 1985: 1978: 1934: 1933: 1929: 1906:(10): 571–576. 1893: 1892: 1888: 1879: 1878: 1874: 1830: 1829: 1825: 1816: 1815: 1811: 1804:"Ileal Pouches" 1802: 1801: 1797: 1755: 1754: 1750: 1741: 1740: 1736: 1698: 1697: 1693: 1657: 1656: 1652: 1614: 1613: 1609: 1571: 1570: 1566: 1536: 1535: 1531: 1487: 1486: 1482: 1446: 1445: 1441: 1428: 1427: 1423: 1392:(6130): 85–88. 1379: 1378: 1374: 1369: 1357: 1307: 1270: 1257: 1255:Diet with pouch 1201:from sickness, 1187:large intestine 1183: 1158: 1141: 1132: 1120: 1111: 1098: 1089: 1080: 1071: 1062: 1025: 1011: 992: 960:Pouch prolapse: 942: 895: 883:Cytomegalovirus 869:Cytomegalovirus 857: 829:Celiac disease: 763:Cytomegalovirus 734: 725: 716: 700: 691: 682: 673: 637: 614:toxic megacolon 610: 598:proctocolectomy 593: 585: 578:as the J-pouch. 509: 500: 487: 462: 440: 417: 400: 391: 354: 338: 329: 298: 274:immune mediated 228: 219: 206:Crohn's disease 199:Toxic megacolon 182:Crohn's disease 172: 156: 49:ileo-anal pouch 17: 12: 11: 5: 6568: 6566: 6558: 6557: 6552: 6542: 6541: 6538: 6537: 6526: 6524:IPAA Procedure 6519: 6518:External links 6516: 6515: 6514: 6488:(2): 131–145. 6477: 6449:(7): 812–823. 6433: 6432: 6426: 6425: 6400: 6382: 6357: 6346: 6335: 6310: 6285: 6271: 6251: 6237: 6225: 6211: 6197: 6183: 6163: 6149: 6098: 6069:(2): 207–216. 6049: 6002: 5988: 5951:(6): 665–669. 5931: 5882: 5868: 5851: 5822:(2): 207–216. 5802: 5775:(2): 209–218. 5758: 5711: 5682:(5): 324–327. 5662: 5613: 5566: 5552: 5502: 5483:(4): 188–193. 5460: 5431:(2): 231–237. 5408: 5379:(4): 239–247. 5354: 5339: 5306: 5292: 5277: 5251: 5224:(4): 675–682. 5207: 5180:(8): 920–930. 5163: 5149:10.7869/tg.344 5142:(2): 143–145. 5122: 5063: 5005: 4991: 4948: 4921:(4): 341–345. 4905: 4856: 4813: 4786:(6): 993–997. 4766: 4755: 4726:(4): 239–247. 4703: 4674:(2): 299–310. 4654: 4625:(4): 334–336. 4605: 4554: 4532: 4511:(8): 470–481. 4491: 4480: 4431: 4404:(7): 941–947. 4388: 4339: 4314: 4285:(2): 161–167. 4265: 4237: 4188: 4145: 4096: 4067:(2): 404–410. 4047: 3998: 3973: 3954:(3): S22–S23. 3937: 3912: 3873: 3819: 3769: 3748: 3697: 3643: 3624:(5): 532–536. 3608: 3559: 3530:(5): 508–521. 3510: 3504:Deutsche Welle 3490: 3476: 3429: 3418: 3377: 3336: 3309:(4): 670–677. 3292: 3263: 3234:(4): 493–495. 3214: 3165: 3147: 3095: 3046: 3028: 3007:(8): 898–904. 2987: 2980: 2960: 2931:(4): 239–247. 2911: 2893: 2865: 2838:(4): 401–405. 2821: 2792:(2): 262–268. 2772: 2751:(6): 649–670. 2730: 2702: 2687: 2661: 2632:(2): 131–142. 2611: 2596: 2571: 2542:(7): 843–853. 2522: 2511: 2504:. 2017-05-17. 2487: 2438: 2409:(4): 462–468. 2389: 2360:(4): 239–247. 2333: 2306:(5): 615–620. 2289: 2260:(8): 664–675. 2240: 2229:(4): 443–448. 2209: 2178: 2151:(7): 459–466. 2135: 2121: 2094: 2045: 1993: 1976: 1927: 1886: 1872: 1843:(5): 533–540. 1823: 1809: 1795: 1748: 1734: 1707:(4): 342–346. 1691: 1670:(8): 466–475. 1650: 1607: 1564: 1545:(1): 111–137. 1529: 1480: 1439: 1421: 1371: 1370: 1368: 1365: 1364: 1363: 1356: 1353: 1352: 1351: 1348: 1345: 1339: 1336: 1330: 1327: 1324: 1321: 1315: 1306: 1303: 1275:life insurance 1269: 1266: 1256: 1253: 1249:kidney failure 1182: 1179: 1157: 1154: 1140: 1137: 1131: 1128: 1119: 1116: 1110: 1107: 1097: 1094: 1088: 1085: 1079: 1076: 1070: 1067: 1061: 1058: 1030: 1029: 1024: 1021: 1016: 1015: 1010: 1007: 997: 996: 991: 988: 947: 946: 941: 938: 933:Pelvic sepsis: 900: 899: 894: 891: 873: 872: 856: 853: 833:Celiac disease 739: 738: 733: 730: 724: 721: 715: 712: 699: 696: 690: 687: 681: 678: 672: 669: 668: 667: 654: 636: 633: 609: 606: 592: 589: 584: 581: 580: 579: 561: 557:Sir Alan Parks 546: 508: 505: 499: 496: 486: 483: 471:coloproctology 461: 458: 445:Sir Alan Parks 439: 436: 416: 413: 399: 396: 390: 387: 353: 350: 342:Sir Alan Parks 337: 334: 328: 325: 302:reconstructive 297: 294: 227: 224: 218: 215: 202: 201: 196: 191: 185: 179: 171: 168: 155: 152: 116:Sir Alan Parks 15: 13: 10: 9: 6: 4: 3: 2: 6567: 6556: 6553: 6551: 6548: 6547: 6545: 6536: 6532: 6531: 6527: 6525: 6522: 6521: 6517: 6511: 6507: 6503: 6499: 6495: 6491: 6487: 6483: 6478: 6474: 6470: 6466: 6462: 6457: 6452: 6448: 6444: 6440: 6435: 6434: 6430: 6429: 6414: 6410: 6404: 6401: 6396: 6392: 6386: 6383: 6371: 6367: 6361: 6358: 6355: 6350: 6347: 6344: 6339: 6336: 6324: 6320: 6314: 6311: 6299: 6295: 6289: 6286: 6281: 6275: 6272: 6267: 6266: 6261: 6255: 6252: 6247: 6241: 6238: 6234: 6229: 6226: 6221: 6215: 6212: 6207: 6201: 6198: 6193: 6187: 6184: 6179: 6178: 6173: 6167: 6164: 6159: 6153: 6150: 6145: 6141: 6136: 6131: 6126: 6121: 6117: 6113: 6109: 6102: 6099: 6094: 6090: 6085: 6080: 6076: 6072: 6068: 6064: 6060: 6053: 6050: 6045: 6041: 6037: 6033: 6029: 6025: 6021: 6017: 6013: 6006: 6003: 5998: 5992: 5989: 5984: 5980: 5976: 5972: 5967: 5966:10044/1/58210 5962: 5958: 5954: 5950: 5946: 5942: 5935: 5932: 5927: 5923: 5919: 5915: 5910: 5905: 5901: 5897: 5893: 5886: 5883: 5878: 5872: 5869: 5864: 5858: 5856: 5852: 5847: 5843: 5838: 5833: 5829: 5825: 5821: 5817: 5813: 5806: 5803: 5798: 5794: 5790: 5786: 5782: 5778: 5774: 5770: 5762: 5759: 5754: 5750: 5746: 5742: 5738: 5734: 5730: 5726: 5722: 5715: 5712: 5707: 5703: 5699: 5695: 5690: 5685: 5681: 5677: 5673: 5666: 5663: 5658: 5654: 5650: 5646: 5641: 5636: 5632: 5628: 5624: 5617: 5614: 5609: 5605: 5601: 5597: 5593: 5589: 5585: 5581: 5577: 5570: 5567: 5564: 5559: 5557: 5553: 5548: 5544: 5540: 5536: 5532: 5528: 5524: 5520: 5516: 5509: 5507: 5503: 5498: 5494: 5490: 5486: 5482: 5478: 5474: 5467: 5465: 5461: 5456: 5452: 5448: 5444: 5439: 5434: 5430: 5426: 5422: 5415: 5413: 5409: 5404: 5400: 5395: 5390: 5386: 5382: 5378: 5374: 5370: 5363: 5361: 5359: 5355: 5350: 5346: 5342: 5336: 5332: 5328: 5324: 5323: 5315: 5313: 5311: 5307: 5302: 5296: 5293: 5288: 5284: 5280: 5278:9780128094020 5274: 5270: 5266: 5262: 5255: 5252: 5247: 5243: 5239: 5235: 5231: 5227: 5223: 5219: 5211: 5208: 5203: 5199: 5195: 5191: 5187: 5183: 5179: 5175: 5167: 5164: 5159: 5155: 5150: 5145: 5141: 5137: 5133: 5126: 5123: 5118: 5114: 5109: 5104: 5100: 5096: 5091: 5086: 5082: 5078: 5074: 5067: 5064: 5059: 5055: 5050: 5045: 5041: 5037: 5033: 5029: 5026:(2): 94–100. 5025: 5021: 5017: 5009: 5006: 5001: 4995: 4992: 4987: 4983: 4979: 4975: 4971: 4967: 4963: 4959: 4952: 4949: 4944: 4940: 4936: 4932: 4928: 4924: 4920: 4916: 4909: 4906: 4901: 4897: 4893: 4889: 4884: 4879: 4875: 4871: 4867: 4860: 4857: 4852: 4848: 4844: 4840: 4836: 4832: 4828: 4824: 4817: 4814: 4809: 4805: 4801: 4797: 4793: 4789: 4785: 4781: 4777: 4770: 4767: 4764: 4759: 4756: 4751: 4747: 4742: 4737: 4733: 4729: 4725: 4721: 4717: 4710: 4708: 4704: 4699: 4695: 4690: 4685: 4681: 4677: 4673: 4669: 4665: 4658: 4655: 4650: 4646: 4641: 4636: 4632: 4628: 4624: 4620: 4616: 4609: 4606: 4601: 4597: 4592: 4587: 4582: 4577: 4573: 4569: 4565: 4558: 4555: 4549: 4544: 4536: 4533: 4528: 4524: 4519: 4514: 4510: 4506: 4502: 4495: 4492: 4489: 4484: 4481: 4476: 4472: 4467: 4462: 4458: 4454: 4450: 4446: 4442: 4435: 4432: 4427: 4423: 4419: 4415: 4411: 4407: 4403: 4399: 4392: 4389: 4384: 4380: 4375: 4370: 4366: 4362: 4358: 4354: 4350: 4343: 4340: 4328: 4324: 4318: 4315: 4310: 4306: 4301: 4296: 4292: 4288: 4284: 4280: 4276: 4269: 4266: 4254: 4247: 4241: 4238: 4233: 4229: 4225: 4221: 4216: 4211: 4207: 4203: 4199: 4192: 4189: 4184: 4180: 4176: 4172: 4168: 4164: 4160: 4156: 4149: 4146: 4141: 4137: 4133: 4129: 4124: 4119: 4115: 4111: 4107: 4100: 4097: 4092: 4088: 4084: 4080: 4075: 4070: 4066: 4062: 4058: 4051: 4048: 4043: 4039: 4035: 4031: 4026: 4021: 4017: 4013: 4009: 4002: 3999: 3987: 3983: 3977: 3974: 3969: 3965: 3961: 3957: 3953: 3949: 3941: 3938: 3926: 3922: 3916: 3913: 3908: 3904: 3900: 3896: 3892: 3888: 3884: 3877: 3874: 3869: 3865: 3860: 3855: 3851: 3847: 3843: 3839: 3835: 3828: 3826: 3824: 3820: 3815: 3811: 3806: 3801: 3797: 3793: 3789: 3785: 3781: 3773: 3770: 3765: 3761: 3755: 3753: 3749: 3744: 3740: 3735: 3730: 3725: 3720: 3716: 3712: 3708: 3701: 3698: 3693: 3689: 3685: 3681: 3676: 3671: 3667: 3663: 3659: 3652: 3650: 3648: 3644: 3639: 3635: 3631: 3627: 3623: 3619: 3612: 3609: 3604: 3600: 3596: 3592: 3587: 3582: 3578: 3574: 3570: 3563: 3560: 3555: 3551: 3546: 3541: 3537: 3533: 3529: 3525: 3521: 3514: 3511: 3506: 3505: 3500: 3494: 3491: 3486: 3480: 3477: 3472: 3468: 3464: 3460: 3456: 3452: 3448: 3444: 3440: 3433: 3430: 3427: 3422: 3419: 3414: 3410: 3405: 3400: 3396: 3392: 3388: 3381: 3378: 3373: 3369: 3364: 3359: 3355: 3351: 3347: 3340: 3337: 3332: 3328: 3324: 3320: 3316: 3312: 3308: 3304: 3296: 3293: 3281: 3274: 3267: 3264: 3259: 3255: 3251: 3247: 3242: 3237: 3233: 3229: 3225: 3218: 3215: 3210: 3206: 3202: 3198: 3193: 3188: 3184: 3180: 3176: 3169: 3166: 3161: 3157: 3151: 3148: 3143: 3139: 3135: 3131: 3126: 3121: 3117: 3113: 3109: 3102: 3100: 3096: 3091: 3087: 3082: 3077: 3073: 3069: 3065: 3061: 3057: 3050: 3047: 3042: 3038: 3032: 3029: 3024: 3020: 3015: 3010: 3006: 3002: 2998: 2991: 2988: 2983: 2977: 2973: 2972: 2964: 2961: 2956: 2952: 2947: 2942: 2938: 2934: 2930: 2926: 2922: 2915: 2912: 2907: 2903: 2897: 2894: 2882: 2875: 2869: 2866: 2861: 2857: 2853: 2849: 2845: 2841: 2837: 2833: 2825: 2822: 2817: 2813: 2808: 2803: 2799: 2795: 2791: 2787: 2783: 2776: 2773: 2768: 2764: 2759: 2754: 2750: 2746: 2742: 2734: 2731: 2719: 2712: 2706: 2703: 2698: 2694: 2690: 2684: 2680: 2676: 2672: 2665: 2662: 2657: 2653: 2648: 2643: 2639: 2635: 2631: 2627: 2623: 2615: 2612: 2607: 2603: 2599: 2593: 2589: 2585: 2581: 2575: 2572: 2567: 2563: 2558: 2553: 2549: 2545: 2541: 2537: 2533: 2526: 2523: 2520: 2515: 2512: 2507: 2503: 2502: 2497: 2491: 2488: 2483: 2479: 2474: 2469: 2465: 2461: 2457: 2453: 2449: 2442: 2439: 2434: 2430: 2425: 2420: 2416: 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1013: 1012: 1008: 1006: 1005:dysfunction. 1003: 1002: 994: 993: 989: 987: 984: 983: 978: 976: 975:Hegar dilator 971: 970: 965: 962: 961: 956: 953: 952: 944: 943: 939: 937: 935: 934: 929: 927: 926: 921: 918: 917: 912: 909: 908: 903: 897: 896: 892: 890: 888: 884: 880: 879: 870: 866: 864: 859: 858: 854: 852: 849: 848: 843: 841: 837: 834: 831: 830: 825: 822: 818: 815: 814: 809: 806: 801: 797: 794: 790: 787: 786: 781: 777: 774: 770: 766: 764: 760: 758: 752: 748: 745: 744: 736: 735: 731: 729: 722: 720: 713: 711: 709: 708:fertilization 707: 697: 695: 688: 686: 679: 677: 670: 664: 660: 659: 655: 652: 648: 647: 643: 642: 641: 634: 632: 630: 626: 622: 617: 615: 607: 605: 603: 599: 590: 588: 582: 576: 572: 571:John Nicholls 568: 567: 562: 558: 553: 552: 547: 544: 540: 539: 534: 533: 532: 530: 526: 522: 518: 514: 506: 504: 497: 495: 493: 484: 482: 480: 476: 472: 468: 459: 457: 454: 450: 449:John Nicholls 446: 437: 435: 433: 428: 426: 422: 414: 412: 408: 405: 404:John Nicholls 397: 395: 388: 386: 382: 380: 376: 370: 368: 364: 360: 359:John Nicholls 349: 347: 343: 335: 333: 326: 324: 322: 318: 313: 311: 307: 303: 295: 293: 289: 287: 283: 279: 275: 270: 267: 263: 259: 254: 252: 248: 243: 241: 237: 233: 225: 223: 216: 214: 211: 207: 200: 197: 195: 192: 189: 186: 183: 180: 177: 174: 173: 169: 167: 165: 161: 153: 151: 148: 144: 140: 135: 131: 129: 128:John Nicholls 125: 121: 117: 113: 109: 104: 102: 101:ostomy system 96: 94: 90: 86: 82: 78: 74: 70: 66: 62: 58: 54: 50: 46: 42: 38: 34: 30: 26: 22: 6528: 6485: 6481: 6446: 6442: 6416:. Retrieved 6412: 6403: 6394: 6385: 6373:. Retrieved 6369: 6360: 6349: 6338: 6326:. Retrieved 6322: 6319:"badgut.org" 6313: 6301:. Retrieved 6297: 6288: 6274: 6263: 6254: 6240: 6228: 6214: 6200: 6186: 6175: 6166: 6152: 6115: 6111: 6101: 6066: 6062: 6052: 6022:(1): 33–38. 6019: 6015: 6005: 5991: 5948: 5944: 5934: 5899: 5895: 5885: 5871: 5819: 5815: 5805: 5772: 5768: 5761: 5728: 5724: 5714: 5679: 5675: 5665: 5630: 5626: 5616: 5583: 5579: 5569: 5522: 5518: 5480: 5476: 5428: 5424: 5376: 5372: 5321: 5295: 5260: 5254: 5221: 5217: 5210: 5177: 5173: 5166: 5139: 5135: 5125: 5080: 5076: 5066: 5023: 5019: 5008: 4994: 4961: 4957: 4951: 4918: 4914: 4908: 4873: 4869: 4859: 4829:(2): 57–59. 4826: 4822: 4816: 4783: 4779: 4769: 4758: 4723: 4719: 4671: 4667: 4657: 4622: 4618: 4608: 4574:(2): 95–98. 4571: 4567: 4557: 4535: 4508: 4504: 4494: 4483: 4448: 4444: 4434: 4401: 4397: 4391: 4356: 4352: 4342: 4330:. Retrieved 4326: 4317: 4282: 4278: 4268: 4256:. 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Retrieved 2717: 2705: 2670: 2664: 2629: 2626:Gut Microbes 2625: 2614: 2579: 2574: 2539: 2535: 2525: 2514: 2499: 2490: 2455: 2451: 2441: 2406: 2402: 2392: 2357: 2353: 2303: 2299: 2292: 2257: 2253: 2243: 2226: 2222: 2212: 2195: 2191: 2181: 2148: 2144: 2138: 2124: 2107: 2103: 2097: 2062: 2058: 2048: 2013: 2009: 1944: 1940: 1930: 1903: 1899: 1889: 1875: 1840: 1836: 1826: 1812: 1798: 1765: 1761: 1751: 1737: 1704: 1700: 1694: 1667: 1663: 1653: 1620: 1616: 1610: 1577: 1573: 1567: 1542: 1538: 1532: 1497: 1493: 1483: 1456: 1452: 1442: 1433: 1424: 1389: 1385: 1375: 1308: 1299: 1291: 1271: 1262: 1258: 1234: 1215: 1184: 1175: 1171: 1167: 1159: 1150: 1146: 1142: 1133: 1121: 1112: 1099: 1090: 1081: 1072: 1063: 1054: 1035: 1031: 1017: 1000: 999: 998: 981: 980: 979: 968: 967: 966: 959: 958: 957: 950: 949: 948: 932: 931: 930: 924: 923: 922: 915: 914: 913: 906: 905: 904: 901: 886: 881:(C-diff) or 877: 874: 867:(C Diff) or 862: 846: 845: 844: 839: 838: 828: 827: 826: 820: 819: 812: 811: 810: 799: 798: 792: 791: 784: 783: 782: 778: 772: 771: 767: 761:(C-diff) or 756: 750: 749: 742: 741: 740: 726: 717: 705: 701: 692: 683: 674: 663:dentate line 657: 656: 645: 644: 638: 620: 618: 611: 594: 586: 565: 564: 550: 549: 537: 536: 510: 501: 488: 463: 441: 429: 418: 409: 401: 392: 383: 371: 366: 355: 339: 330: 314: 299: 290: 271: 255: 244: 229: 220: 203: 194:Colon cancer 157: 136: 132: 105: 99:known as an 97: 69:pelvic pouch 68: 64: 60: 56: 52: 48: 44: 40: 36: 32: 28: 24: 18: 6395:J-pouch.org 2198:: 249–251. 1281:, and some 1241:salt levels 1218:Dehydration 1050:hypokalemia 432:Mayo Clinic 348:, in 1976. 245:While both 73:anastomosis 6544:Categories 3760:"UpToDate" 3156:"UpToDate" 2718:Bsg.org.uk 1617:The Lancet 1367:References 1124:Kock pouch 860:examples: 805:Mesalazine 629:sphincters 523:after the 467:Colorectal 375:Kock pouch 266:autoimmune 139:Kock pouch 5099:2198-7793 5040:2287-9714 4232:231757564 3968:214100116 3692:231757564 3449:: e3656. 3413:243882359 3397:(2): e9. 3372:237909836 3331:201041225 3280:Siccr.org 3118:: 25–28. 2860:244946770 2040:231757564 1971:231757564 1500:: 25–28. 1459:: 57–59. 1247:and even 1228:, and/or 1222:dizziness 1046:magnesium 1042:potassium 916:Fistulas: 865:infection 785:Cuffitis: 759:infection 743:Pouchitis 646:Hand Sewn 602:ileostomy 473:, and/or 379:Nils Kock 310:sphincter 286:arthritis 249:(UC) and 147:ileostomy 143:Nils Kock 93:ileostomy 6510:20465425 6502:16432378 6465:17571291 6144:24151365 6093:31914113 5975:29575955 5918:28259741 5846:31914113 5797:53562347 5789:30444323 5753:23562471 5745:10215050 5698:17630490 5657:28111412 5649:24980779 5608:25433632 5600:28649762 5547:25433632 5539:28649762 5497:81382071 5455:28174194 5447:16432813 5403:22131894 5349:53231858 5287:58562381 5246:37923611 5238:26366548 5202:49432491 5194:29944583 5158:30234947 5117:34982288 5083:(1): 2. 5058:29742859 4986:41258502 4978:16393238 4943:28205799 4935:18545871 4892:28259741 4851:11723426 4808:11614275 4800:20393806 4750:22131894 4698:26240633 4649:26163670 4600:28250903 4527:30302062 4475:23974995 4426:42268836 4418:24989088 4383:23974995 4309:20041883 4224:33523546 4183:33569639 4175:21731025 4132:27057684 4091:25476160 4083:23328773 4042:23951765 4034:11736972 3907:11939487 3868:20011284 3814:30810748 3743:26269664 3684:33523546 3638:29630001 3603:26625368 3595:18266993 3554:26766924 3471:31251319 3463:22623641 3323:31420214 3258:19847943 3250:10215821 3209:23951765 3201:11736972 3142:73237348 3134:12047256 3090:16794385 3023:26874347 2955:22131894 2852:34871117 2816:15650636 2767:28158501 2697:53231858 2656:28914591 2566:22228116 2506:Archived 2501:CBC News 2482:15383789 2384:22131894 2328:29144312 2320:10826420 2276:29577558 2173:23749131 2116:20240241 2032:33523546 1963:33523546 1922:30846911 1867:22392947 1790:25619933 1782:15307872 1729:28274214 1686:28867978 1645:40967933 1602:40967933 1559:19845173 1524:73237348 1516:12047256 1475:21308013 1355:See also 1320:- Canada 1295:Medicaid 1203:sweating 1199:vomiting 1195:diarrhea 706:in vitro 306:curative 304:and not 236:curative 71:, is an 21:medicine 6473:8337023 6418:20 July 6375:20 July 6328:20 July 6303:20 July 6135:3801317 6084:7071733 6044:7601415 6036:7745321 5983:4305191 5926:4359718 5837:7071733 5706:7840290 5394:3134803 5108:8727658 5049:5951091 4900:4359718 4843:8739827 4741:3134803 4689:4520842 4640:5193055 4591:5311479 4543:medRxiv 4518:6170888 4466:4085480 4374:4085480 4332:20 July 4300:2857938 4258:20 July 4140:3341414 3991:20 July 3930:20 July 3893:(1–2). 3859:2780072 3805:6939832 3734:4528017 3545:4707671 3303:Surgery 3285:20 July 3081:1570587 2946:3134803 2886:20 July 2807:1356911 2723:20 July 2647:5989788 2606:1135267 2557:3378834 2473:1356463 2433:6625717 2424:1353186 2375:3134803 2284:4969365 2235:9168499 2204:2474971 2165:6777128 2080:1605901 1913:6384396 1858:3307558 1721:9523514 1677:5572960 1637:8622390 1594:8622390 1466:2378183 1407:1605901 1230:fatigue 982:U-bend: 658:Stapled 566:W-pouch 551:S-pouch 538:J-pouch 361:joined 336:History 282:uveitis 67:, or a 65:W-pouch 61:S-pouch 57:J-pouch 6508: 6500: 6471: 6463: 6265:Forbes 6177:Forbes 6142: 6132: 6091: 6081: 6042: 6034: 5981: 5973: 5924: 5916: 5844: 5834: 5795: 5787: 5751: 5743: 5704: 5696: 5655: 5647: 5606: 5598: 5545: 5537: 5495: 5453: 5445: 5401: 5391: 5347: 5337: 5285: 5275: 5244: 5236: 5200: 5192: 5156: 5115: 5105: 5097: 5056: 5046: 5038: 4984: 4976: 4941: 4933: 4898: 4890: 4849: 4841: 4806: 4798: 4748: 4738: 4696: 4686: 4647: 4637: 4598: 4588: 4545: 4525: 4515: 4473: 4463: 4424: 4416: 4381: 4371: 4307: 4297: 4230: 4222: 4181: 4173: 4138: 4130: 4089: 4081: 4040: 4032: 3986:Ueg.eu 3966: 3905: 3866: 3856: 3812: 3802: 3741: 3731: 3690: 3682: 3636: 3601: 3593: 3552: 3542: 3469: 3461: 3411: 3370: 3329: 3321: 3256: 3248: 3207: 3199: 3140: 3132: 3088: 3078: 3021: 2978: 2953: 2943: 2858: 2850: 2814: 2804: 2765: 2695: 2685: 2654: 2644: 2604: 2594: 2564: 2554: 2480: 2470: 2431: 2421: 2382: 2372: 2326: 2318: 2282: 2274: 2233: 2202: 2171: 2163: 2114: 2089:667572 2087: 2077: 2038: 2030: 1969: 1961: 1920: 1910: 1865: 1855: 1788: 1780: 1727: 1719: 1684: 1674: 1643: 1635: 1600: 1592: 1574:Lancet 1557: 1522: 1514: 1473: 1463: 1416:667572 1414: 1404: 1211:fluids 1044:, and 625:rectum 529:rectum 164:rectum 108:rectum 47:), an 23:, the 6506:S2CID 6469:S2CID 6431:Notes 6040:S2CID 5979:S2CID 5922:S2CID 5793:S2CID 5749:S2CID 5702:S2CID 5653:S2CID 5604:S2CID 5543:S2CID 5493:S2CID 5451:S2CID 5345:S2CID 5283:S2CID 5242:S2CID 5198:S2CID 4982:S2CID 4939:S2CID 4896:S2CID 4847:S2CID 4804:S2CID 4422:S2CID 4249:(PDF) 4228:S2CID 4179:S2CID 4136:S2CID 4087:S2CID 4038:S2CID 3964:S2CID 3903:S2CID 3688:S2CID 3599:S2CID 3467:S2CID 3409:S2CID 3368:S2CID 3327:S2CID 3276:(PDF) 3254:S2CID 3205:S2CID 3138:S2CID 2877:(JPG) 2856:S2CID 2714:(PDF) 2693:S2CID 2602:S2CID 2324:S2CID 2280:S2CID 2169:S2CID 2036:S2CID 1967:S2CID 1786:S2CID 1725:S2CID 1641:S2CID 1598:S2CID 1520:S2CID 1237:fluid 1191:ileum 871:(CMV) 543:stool 525:colon 517:ileum 190:(FAP) 160:colon 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