Postoperative Morbidity

Although both IPAA and IRA procedures qualify as major abdominal operations, performing an IRA is perceived as being an easier and less complicated procedure, associated with less post-operative morbidity [15]. Factors that are thought to play a part in this include increased operative time, hospital stay and blood loss, all of which have been suggested as being greater with IPAA [13]. This procedure may also involve the formation of a temporary defunc-tioning ileostomy in order to minimise the risk of anastomotic leakage and pelvis sepsis [25]. There are however complications and disadvantages related to this additional procedure, which requires closure under general anaesthetic at a later date [26,27]. This has led to several groups avoiding defunctioning ileostomy with IPAA altogether, with encouraging results [27, 28]. The question of whether IRA is suitable for young patients, who are more likely to require a later rectal excision due to polyp recurrence or rectal cancer, or whether these patients are better served with a one-stage restorative proctocolectomy, mucosectomy, and IPAA, particularly in those with severe FAP phenotype, has been considered and remains to be answered [13]. Secondary IPAA is a procedure in which technical difficulties are more common than primary IPAA for both UC and FAP [29, 30], with some suggesting significantly higher complication rates due to technical difficulties and increased age at presentation [31], and others suggesting that it can be performed safely [20].

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