Restorative Proctocolectomy with Ileal Reservoir: Pouch Configuration and Volume

Restorative proctocolectomy with ileal reservoir has become an accepted form of treatment for ulcerative colitis and familial adenomatous polyposis. Five types of reservoirs have been developed: the S pouch, J pouch, H pouch, W pouch and K pouch. This paper reviews the differences in the clinical and functional outcomes among the various reservoir designs and their sizes. From the results of the reported series, the best clinical function is apparently that associated with a large volume and highly compliant pouch which empties spontaneously. The S pouch has a high rate (3553%) of catheterization for evacuation. On the other hand, the Wand K pouches have larger and wider reservoirs with a higher compliance than of the J pouch. However, since cases in which the K pouch as well as H pouch have been used are few, a larger number of patients will be necessary to reach a conclusion regarding the best treatment. The present conclusion is that the W pouch has the best functional outcome concerning defecation.