Pelvic Pouch Failure: Treatment Options

Abstract

Up to 30% of patients with ulcerative colitis (UC) will require surgical management of their disease during their lifetime. An ileal pouch-anal anastomosis (IPAA) is the gold standard of care, giving patients the ability to be free from UC's bowel disease and avoid a permanent ostomy. Despite surgical advancements, a minority of patients will still experience pouch failure which can be debilitating and often require further surgical interventions. Signs and symptoms of pouch failure should be addressed with the appropriate workup and treatment plans formulated according with the patient's wishes. This article will discuss the identification, workup, and treatment options for pouch failure after IPAA.

Restorative pouch surgery following proctocolectomy for inflammatory bowel disease: past experience and future direction

“…The redo or revisional IPAA operation is typically completed after a “thoughtful ileostomy” is has been in place for 6 months, however other indications for revisional operations such as a tip of the J leak or adhesive disease like afferent limb syndrome may not require a preoperative diverting stoma ( 59 ). Tip of the J leaks may only require isolation of the leak and oversewing or re-stapling with or without diversion ( 60 ).…”

“…Tip of the J leaks may only require isolation of the leak and oversewing or re-stapling with or without diversion ( 60 ). The senior author of this article has successfully attempted and completed two laparoscopic revisional IPAA operations in highly selected patients who had their index pouch created laparoscopically, however only a limited number of minimally invasive redo pouch procedures have been attempted and the standard operation is a formal laparotomy with full abdominopelvic pouch mobilization ( 59 , 61 ). Robotic redo IPAA has not been published to date, however robotic pouch excision has been described ( 62 ).…”