IAA and IACA Difference (Technical Questions)

RinaJPMember

Terms
IAA: ileoanal anastomosis
IACA: Ileoanal canal anastomosis
IPAA: Ileo pouch-anal anastomosis

I know this is a highly technical question, but I'm trying to find the correct terminology for my j-pouch surgery in Japanese, and in Japan they seem to distinctly differentiate the IPAA into IAA and IACA. The way that the Japanese define the IAA is having a 3-step surgery and connecting the pouch to the anus whereas the IACA is having a 2-step surgery and connecting the pouch to the rectum, leaving a small part of the rectum for sphincter control. In the US, I guess for simplicity sake lumps both types of surgeries into the IPAA category without differentiating between the two.

Do people actually know which surgery they had, or do people just generally lump everything under j-pouch (IPAA)? In recent surgeries, is it now the norm to actually have a rectal cuff for both 2-step and 3-step?

I guess you could say I'm somewhat confused as to whether or not I actually have a rectal cuff because I had a 3-step surgery about 14 years ago, and my understanding is that I had a mucosectomy with my j-pouch, but it was never explained if I had a remaining rectal cuff. I know I'll have to ask my GI here as to whether or not I actually have a cuff because I have ulcers around the anastomosis, but it's quite unclear as to whether I have a cuff or not. Also, my surgeon back in the states is quite unresponsive, so I guess I'm kind of fishing for an answer so that I can translate correctly as to which surgery I actually have because in Japanese, it only has a translation for IAA and IACA, and does not generalize into IPAA.

Sorry for the long technical spew, but if anyone has any insight, it would be greatly appreciated.

-Rina

1/8/181:32 AM

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Scott FMember

The norm in the US is to leave a rectal cuff and staple the anastomosis, regardless of the number of steps/surgeries. This tends to have a better overall success rate, but (as you’ve experienced) leaves open the possibility of cuffitis. Mucosectomy isn’t always (or even usually) performed, as far as I know, but surgeons seem to vary. Perhaps you could request a copy of your hospital record and read your operative report. The hardest part may be providing an old-fashioned signature authorizing release, but a FAXed signature will generally do the trick. This is a very reasonable question for your surgeon, and I’m sorry you’re having trouble getting an answer.

I think the various terms may be used carelessly in the US, so I’d avoid assuming that you know what was done based on the acronym used. I suggest that instead of asking for the name of the procedure, you turn it into three straightforward questions: 1) was the anastomosis made to a rectal cuff or directly to the anus?, 2) was the anastomosis stapled or hand-stitched?, and 3) was a mucosectomy performed?

Good luck!

1/8/189:40 AM

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RinaJPMember

Hi Scott,

I am sorry for the late reply. I confirmed with my GI that I do have some of my colon left. Though, I probably can't confirm if it was stapled or if there was a musectomy. My ulcers are around the connection in both the colon and small bowel, but not anywhere else in the pouch. It's extremely frustrating finding something that works because it isn't cuffitis or pouchitis (so my doctor thinks), so standstill still continues this year. I'm out of ideas as to what might work.

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