Total abdominal proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) is associated with substantial complications despite the benefits of managing refractory and/or neoplasia-associated disease. For the purpose of this review, we focused on the diagnosis of some of the most common inflammatory and structural pouch disorders and their respective management. Pouchitis is the most common complication, and it is typically responsive to antibiotics. However, chronic antibiotic refractory pouchitis (CARP) has been increasingly recognized, and biologic therapies have emerged as the mainstay of therapy. Crohn's-like disease of the pouch (CLDP) can affect up to 10% of patients with UC after IPAA. Medical options are similar to CARP therapies, including biologics with immunomodulators. Studies have shown higher efficacy rates of biologics for CLDP when compared with those for CARP. In addition, managing stricturing and fistulizing CLDP is challenging and often requires interventional endoscopy (balloon dilation and/or stricturotomy) and/or surgery. The implementation of standardized diagnostic criteria for inflammatory pouch disorders will help in advancing future therapeutic options. Structural pouch disorders are commonly related to surgical complications after IPAA. We focused on the diagnosis and management of anastomotic leaks, strictures, and floppy pouch complex. Anastomotic leaks and anastomotic strictures occur in approximately 15% and 11% of patients with UC after IPAA, respectively. Further complications from pouch leaks include the development of sinuses, fistulas, and pouch sepsis requiring excision. Novel endoscopic interventions and less invasive surgical procedures have emerged as options for the management of these disorders.

中文翻译：

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J 囊疾病的分类和治疗。

尽管对治疗难治性和/或肿瘤相关疾病有好处，但针对溃疡性结肠炎（UC）的全腹部直肠结肠切除术联合回肠贮袋肛门吻合术（IPAA）仍会带来严重的并发症。出于本次综述的目的，我们重点讨论了一些最常见的炎症性和结构性储袋疾病的诊断及其各自的治疗。储袋炎是最常见的并发症，通常对抗生素有反应。然而，慢性抗生素难治性贮袋炎（CARP）已越来越受到人们的重视，生物疗法已成为主要的治疗方法。克罗恩病样储袋病 (CLDP) 可能影响 IPAA 后高达 10% 的 UC 患者。医疗选择与 CARP 疗法类似，包括含有免疫调节剂的生物制剂。研究表明，与 CARP 相比，生物制剂治疗 CLDP 的有效率更高。此外，管理 CLDP 狭窄和瘘管具有挑战性，通常需要介入内窥镜检查（球囊扩张和/或狭窄切开术）和/或手术。炎症袋疾病标准化诊断标准的实施将有助于推进未来的治疗选择。结构性储袋疾病通常与 IPAA 后的手术并发症有关。我们专注于吻合口瘘、狭窄和软袋复合体的诊断和治疗。IPAA 后 UC 患者中约 15% 和 11% 发生吻合口瘘和吻合口狭窄。造口袋渗漏的其他并发症包括形成鼻窦、瘘管和需要切除的造口袋脓毒症。新型内窥镜干预和微创外科手术已成为治疗这些疾病的选择。