Operative, long‐term and quality of life outcomes after salvage of failed re‐do ileal pouch anal anastomosis

Abstract

Aim Approximately 20%–40% of the patients with re‐do ileal pouch anal anastomosis (IPAA) experience pouch failure. Salvage surgery can be attempted in this patient group with severe aversion to permanent ileostomy. The literature regarding secondary IPAA revision after re‐do IPAA failure is scarce. Methods All patients who underwent a secondary IPAA revision after re‐do IPAA failure between September 2016 and July 2021 in a single centre were included. Short‐ and long‐term outcomes and quality of life in this patient group are reported. Results Ten patients who had secondary IPAA revision for re‐do IPAA failure were included. All patients had ulcerative colitis. Nine of these patients had pelvic sepsis and one patient had a mechanical issue. Mucosectomy and handsewn anastomosis was performed in nine patients. The existing pouch was salvaged in six patients and four patients had pouch excision and re‐creation. Two patients had postoperative pelvic sepsis. Pouch retention rate was 78% in a median of 28 months. None of the patients had short‐gut syndrome. The procedure was associated with good quality of life (median Cleveland Global Quality of Life Index 0.8). All patients would undergo the same surgery if needed. Conclusion Secondary IPAA revision after a failed re‐do IPAA can be an option in patients with severe aversion to permanent ileostomy if re‐do IPAA fails and it is associated with good outcomes. This patient group should be carefully evaluated and referred to specialized centres if required.

Third Time’s the Charm? Indications and Outcomes for Redo-Redo IPAA

“…8,10,11 Despite the lack of statistical significance, the trend toward higher pouch failure in the cohort with a final diagnosis of CD suggests that a careful preoperative work up is warranted in those patients. However, the overall pouch retention rate was similar to that reported by Esen et al, 9 who in their study had 10 patients who underwent a second redo pouch procedure, 9 and comparable to the retention rate of first redo pouches. 7,8 Affording patients an acceptable quality of life without a permanent ileostomy is the ultimate goal of any pouch salvage procedure.…”

Ileoanal pouch revision and excision surgery in a newly established pouch center. Requirements and costs for service provision

“…Centralizing the care of patients undergoing primary and revisional ileoanal pouch surgery in few dedicated pouch units, could result in increased volume of activities, making it more appropriate for those units to invest into the service, with resulting bene ts for training and nurturing expertise across different specialties. As a matter of fact, gaining experience in pouch surgery is not easy, as the procedure is performed infrequently across many hospitals, as reported by the UK Pouch registry [1], outlining that the average number of pouches performed in English institutions was just three cases per year and one quarter of the surgeons undertaking this operation had performed only one case over the last ve years.…”

“…Mechanical complications of the ileoanal pouch affecting function and quality of life may require surgical correction or pouch excision [1]. It is well known that ileoanal pouch surgery is performed infrequently, making it di cult for surgeons and multidisciplinary team members to develop expertise in ileoanal pouch anastomosis (IPAA) surgery [2], and even more in revisional and excisional surgery.…”

Pelvic Pouch Failure: Treatment Options

“…33 Pushing the envelope, this latter group reported a small series of 10 patients that underwent a second redo IPAA, with a follow up of 28 months, pouch retention rate was 78%. 34 In terms of functional outcomes and QOL, patients that underwent revisional surgery seem to fare worse than patients with a primary pouch. A recent meta-analysis of revisional ileoanal pouch surgery compared with primary pouches, with 2,400 patients found that revisional surgery was associated with a greater frequency of day-time bowel movements (4.1 vs. 7.4, p < 0.0001), a greater frequency of night-time bowel movements (2.6 vs. 1.8, p < 0.002), a higher proportion of patients reporting fecal incontinence (62.3% vs. 34.8%, p ¼ 0.0119), a higher proportion of patients reporting urgency/soiling (20.8% vs. 3.8% p ¼ 0.0062), as well as worse QOL evaluated with the Cleveland Global Quality of Life Questionnaire.…”

“…33 Pushing the envelope, this latter group reported a small series of 10 patients that underwent a second redo IPAA, with a follow up of 28 months, pouch retention rate was 78%. 34…”