The ileal pouch anal anastomosis: to divert or not to divert? The case for diversion.

The ileal pouch anal anastomosis is a high-risk anastomosis with a high rate of complications. Because of this proximal diversion has often been done when performing this operation. Recently the practice of proximal diversion has been questioned, noting the high rate of complications associated with the stoma and stomal reversal. However, the cumulative data does suggest that an undiverted ileal pouch anal anastomosis has a higher leak rate and is associated with increased pelvic sepsis. Because of the severity of this complication proximal diversion is still advocated in the majority of cases.