Modified H-pouch as an alternative to the J-pouch for anorectal reconstruction

Aim: A modification is described of the J-pouch to facilitate ileoanal anastomosis in the presence of an anal or anovaginal fistula.

Method: The bowel is divided at the level of the apex of the J-pouch, the distal limb is advanced to project beyond the proximal limb by 3-5 cm. The pouch is constructed by a side-to-side anastomosis to form the H-pouch with a distal ileal segment, which is passed through the anal canal to form an ileoanal anastomosis.

Results: The modification allows the treatment of anal and rectal disorders not resolvable by a usual J-pouch construction, as in cases where a rectal resection is needed for concomitant fistulation or destruction of the anal mucosa. The functional results are similar to those of the J-pouch, with no added postoperative morbidity. This technique helps to avoid permanent stoma in selected cases.

Conclusion: The modified pouch is relatively simple to perform and can help the surgeon to address complex anorectal disorders.