Dr. Pär Myrelid, President of the Swedish Society of Colorectal Surgeons, reviews the evidence on ileorectal anastomosis (IRA) in ulcerative colitis, comparing it to ileal pouch-anal anastomosis (IPAA).
Concerning bowel function, reports show that after ileo-rectal anastomosis most patients have between 3 to 6 bowel movements and have better continence scores compared to IPAA, but also have more urgencies. Nevertheless there seems to be no differences in terms of quality of life between IRA and IPAA.
There seems to be better physical and sexual functioning with IRA compared to IPAA, especially in Ulcerative Colitis Patients compared to patients with Familial Adenomatous Polyposis. The literature also shows an increase in infertility for IPAA compared to IRA.
Dr. Myrelid proposes to offer IRA in UC to young patients as a temporary solution, with late onset or a short history, with poor sphincter function and a controllable rectum. It should not be offered in cases of cancer or dysplasia, proctitis despite topical therapy, hereditary colorectal cancer, primary sclerosing cholangitis or if the rectum is not distensible.
Follow-up of the rectum should be done by means flexible endoscopy with multiple random biopsies on a yearly basis, and only in cases of early onset and more than 10 years of duration on a half-yearly basis.