**6.2 IPAA pouch confection**

The most used pouch configurations are the J-pouch and de S-pouch, wherein most centers opt for J-pouch. S-pouch is usually reserved for patients with high IBM, short mesentery, or handsewn anastomosis necessity. Wu et al. recommend using an S-pouch when constructing an IPAA with a handsewn technique. A total of 502 patients included 169 patients with an S-pouch (33.7%). The frequencies of short-term complications in the two groups were similar (*p* > 0.05), but pouch fistula or sinus (*p* = 0.047), pelvic sepsis (*p* = 0.044), postoperative partial smallbowel obstruction (*p* = 0.003), or postoperative pouch-related hospitalization (*p* = 0.021) occurred in fewer patients with an S-pouch. At a median follow-up of 12.2 (range, 4.3–20.1) years, patients with an S-pouch were found to have

fewer bowel movements (*p* < 0.001), less frequent pad use (*p* = 0.001), and a lower fecal incontinence severity index score (*p* = 0.015). The pouch failed in 62 patients (12.4%), but neither univariate nor multivariate analysis showed a significant association with pouch configuration IPAA surgery stage [30].
