Randomized, Controlled Trial to Compare the J-Pouch and W-Pouch Configurations for Ulcerative Colitis in the Maturation Period F. Selvaggi, M.D., A. Giuliani, M.D., C. Galto, M.D., G. Signoriello, M.D., G. Riegler, M.D., S. Canonico, M.D. From the VI Division of General Surgery, Second University of Napleg Naples, Italy' PURPOSE: Proctocolectomy with ileal pouch-anal anasto- mosis has become the procedure of choice for the treat- ment of ulcerative colitis. Functional results may differ with different pouch designs. This randomized study ahned to evaluate the relative effectiveness of two-limb J and four- limb W reservoir designs in the so-called maturation period after ileostomy closure. METHODS: Twenty-four patients underwent ileal pouch-anal anastomosis for ulcerative coli- tis. Eleven were randomly- assigned to the J-pouch group and 13 to the W-pouch group. Frequency of defecation and other functional data were collected at 4, 8, and 12 months after ileostomy closure. Maximum tolerated volume was assessed in the same period by a latex balloon inflated with water. Maximum resting anal pressure, maximum voluntary contraction, and the rectoanal inhibitory reflex were as- sessed in the preoperative period and at 4, 8, and 12 months aSter iteostomy closure. RESULTS:FrcNuency of defecation decreased from 4 to 12 months after ileostomy closure in both groups (P = 0.04), but patients with a W-pouch had significantly lower values than patients with J-pouches (P < 0.01). Night-time defecation (P = 0.04) and use of antidiar- rheals (P = 0.04) were siglzificantly lower for patients with a "RI-pouch. Maximum tolerated volume was greater in the W-pouch group throughout the whole period (P = 0.01). Maximum resting anal pressure, maximum voltmtary con- traction, and rectoanal inhibitory reflex did not differ be- tween the study arms CONCLUSION: Patients with W-pouch have better functional results than those with J-pouches in the "maturation period" after ileostomy clo- sure. [Key words: Ulcerative colitis; Randomized controlled trial; Restorative proctocolectomy; Ileal pouch] Selvaggi F, Ginliani A, Gallo C, SignorieUo G, Riegler G, Canonico S. Randomized, controlled trial to compare the J-pouch and W-pouch configurations for ulcerative colitis in the maturation period. Dis Colon Rectum 2000;43:615-620. p roctocolectomy with ileal pouch-anal anastomo- sis (IPAA) has become the procedure of choice for the treatment of ulcerative colitis (UC). 1 In the early 1980s three pouch configurations were intro- duced. The triplicate (S) pouch 2 was associated with a need to catheterize the pouch in more than one-half the patients because of an overly long efferent limb.3, 4 No reprints are available. 615 In 1980 Utsonomiya et al. 5 described a double- lumen, J-shaped pouch. The J-pouch is easily con- stmcted and empties easily; however, frequency of defecation tends to be high. 6 Nicholls and Pezim r popularized the quadruple W- pouch, which produces a large-capacity reservoir, and reported that the frequency of defecation was inversely related to maximum tolerated volume (MTV). A comparison of the functional results between J and W ileal pouch configurations showed similar results, 8 al- though functional results during the so-called matura- tion period after ileostomy closure, 9 in which the frequency of defecation may decrease, were not inves- tigated. The aim of this prospective, randomized study was to compare the early functional effects of IPAA with J or W reservoir design in patients with UC throughout the first year after ileostomy closure. PATIENTS AND METHODS All patients eligible for an IPAA because of UC who were operated on by one surgeon (FS) from March 1992 to November 1996 entered into the trial. Eleven patients were randomly assigned to the double-lumen J-pouch and 13 patients to the quadruple-loop W- pouch during surgery after performing the colectomy. The presence of UC was always confirmed by colec- tomy specimens. Twelve patients had had a previous colectomy for severe active colitis. None of the pa- tients was excluded from the trial. In both groups the surgical technique provided for a total colectomy with division of the ileocolic artery routinely, total rectal excision, division of the rectum approximately 2 cm above the dentate line, transanal mucosectomy, and handsewn pouch-anal anastomo- sis using interrupted 2-0 Vicryl ® (Ethicon, Norder- stedt, Germany) sutures on a 20-mm round-bodied needle.