AIM: There is no consensus as to which ileoanal pouch design provides better 
outcomes after restorative proctocolectomy. This study compares different pouch 
designs.
METHOD: A systematic review of the literature was performed. A random effects 
meta-analytical model was used to compare adverse events and functional outcome.
RESULTS: Thirty comparative studies comparing J, W, S and K pouch designs were 
included. No significant differences were identified between the different pouch 
designs with regard to anastomotic dehiscence, anastomotic stricture, pelvic 
sepsis, wound infection, pouch fistula, pouch ischaemia, perioperative 
haemorrhage, small bowel obstruction, pouchitis and sexual dysfunction. The W 
and K designs resulted in fewer cases of pouch failure compared with the J and S 
designs. J pouch construction resulted in a smaller maximum pouch volume 
compared with W and K pouches. Stool frequency per 24 h and during daytime was 
higher following a J pouch than W, S or K constructions. The J design resulted 
in increased faecal urgency and seepage during daytime compared with the K 
design. The use of protective pads during daytime and night-time was greater 
with a J pouch compared to S or K. The use of antidiarrhoeal medication was 
greater after a J reservoir than a W reservoir. Difficulty in pouch evacuation 
requiring intubation was higher with an S pouch than with W or J pouches.
CONCLUSION: Despite its ease of construction and comparable complication rates, 
the J pouch is associated with higher pouch failure rates and worse function. 
Patient characteristics, technical factors and surgical expertise should be 
considered when choosing pouch design.