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In medicine, the ileal pouchanal anastomosis (ipaa), also known as an ileo-anal pouch, restorative proctocolectomy, ileal-anal pullthrough, or sometimes referred to as a j-pouch, s-pouch, w-pouch or an internal pouch, is an anastomosis of the ileum to the anus, bypassing the former site of the colon in cases where the colon has been removed. It retains or restores functionality of the anus, with stools passed under voluntary control of the patient, preventing fecal incontinence and serving as an alternative to ileostomy. The pouch component is a surgically constructed intestinal reservoir usually situated near where the rectum would normally be. It retains or restores functionality of the anus, with stools passed under voluntary control of the patient, preventing fecal incontinence and serving as an alternative to ileostomy. The pouch component is a surgically constructed intestinal reservoir usually situated near where the rectum would normally be. It is formed by folding loops of small intestine (the ileum) back on themselves and stitching or stapling them together. The internal walls are then removed thus forming a reservoir. The reservoir is then stitched or stapled into the perineum where the rectum was. In occasional reported cases of refractory pouchitis, pouch biopsy specimens contained granulomas or the excised pouch showed histologic criteria for crohns disease. 414,433,436 invariably, the original colectomy showed either missed crohns disease or colitis of an indeterminate type. In some cases, it may be possible to have a permanent internal ileo-anal pouch, also known as a j pouch, formed instead of an ileostomy. An ileo-anal pouch is created from the ileum and joined to the anus, so waste material passes out of your body in the normal way. Key words indications and outcomes, ileo-anal pouch, pouch failure, pouch excision core tip there is currently no single paper in the literature that consolidates the indications for ileo-anal pouch excision and the subsequent outcomes. Ileo-anal pouch surgery can be undertaken as a one, two or three stage procedure. The decision is usually based on the severity of the disease in cases of ulcerative colitis and any medications being taken, particularly steroids. Ensure the pouch is empty by wiggling your hips, gently massaging your abdomen, coughing or standing slightly from the toilet 8.