In patients with UC undergoing restorative proctectomy with ileal J-pouch anal anastomosis, should a DLI be performed to protect the anastomosis

What is known

- In a cohort of high-risk anastomoses, UC restorative proctocolectomy patients were diverted when the anastomosis was less than 5 cm from the anal verge; selective diversion yielded a 1% anastomotic loss rate. ¹ - Diverting loop ileostomy in staged IPAA provides proximal diversion that protects the healing pouch. ²

What is unknown / caveats

- One series concluded diverting ileostomy did not prevent later pouch failure and should be reserved for high-risk patients ³ - Diversion carries its own morbidity: stoma-related complications reported in 5-46%, plus complications and reoperations at closure ^4,5 - The retrieved evidence does not report a randomized comparison of diversion vs no diversion for a defined high-risk IPAA subgroup - The evidence supports protection of the anastomosis by diversion but does not isolate net benefit specifically for the high-risk subgroup versus its added morbidity.

## References

1. PMID: 17434360. (metadata not in corpus)

2. Choi BH, Cohen D, Kitchens C, Schwartzberg DM. Management of J-pouch Complications. Surg Clin North Am. 2025;105:357-373. PMID: 40015821.

3. Karjalainen EK, Renkonen-Sinisalo L, Mustonen HK, Lepistö AH. Morbidity related to diverting ileostomy after restorative proctocolectomy in patients with ulcerative colitis. Colorectal Dis. 2019;21:671-678. PMID: 30698869.

4. Mizushima T, Kameyama H, Watanabe K, Kurachi K, Fukushima K, Nezu R, Uchino M, Sugita A, Futami K. Risk factors of small bowel obstruction following total proctocolectomy and ileal pouch anal anastomosis with diverting loop-ileostomy for ulcerative colitis. Ann Gastroenterol Surg. 2017;1:122-128. PMID: 29863130.

5. Park J, Gessler B, Block M, Angenete E. Complications and Morbidity associated with Loop Ileostomies in Patients with Ulcerative Colitis. Scand J Surg. 2018;107:38-42. PMID: 28485190.

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_Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._