Transabdominal re-do pouch surgery in pediatric patients for failed ileal pouch anal anastomosis: a case matched study

Aytaç, Erman; Esen, Eren; Aydinli, H. Hande; Kirat, Hasan T.; Schwartzberg, David M.; Remzi, Feza H.

doi:10.1007/s00383-019-04493-2

Cited by 4 publications

(3 citation statements)

References 28 publications

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Re-do ileal pouch anal anastomosis (IPAA) is the procedure of choice in patients with failed IPAAs who have severe aversion to living with a permanent stoma [1][2][3]. It is associated with acceptable functional outcomes and quality of life.

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confidence: 99%

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

et al. 2022

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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.

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

et al. 2022

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“…R e-do IPAA is the surgical treatment of choice to maintain gastrointestinal continuity in patients with failed IPAAs who have aversion to permanent stoma because it provides a good quality of life with widely accepted functional outcomes. [1][2][3] Re-do IPAA is associated with high morbidity, and the most dreaded complication is pelvic sepsis (PS) because it is the most common cause of ileal pouch failure. 1 Early diagnosis and treatment of PS is of utmost importance to salvage the ileal pouch.…”

Section: Principales Medidas De Resultadomentioning

confidence: 99%

“…Pelvic sepsis was defined as any infectious process in the peri-pouch area including abscess formation, anastomotic leak, chronic sinus with cavity, or a fistula detected clinically or radiologically. 3,12 Pouch failure was defined as any condition in which the ileostomy cannot be reversed or re-created with or without pouch excision. Urgency was defined as inability to defer bowel movements more than 30 minutes.…”

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confidence: 99%

Management, Functional Outcomes, and Quality of Life After Development of Pelvic Sepsis in Patients Undergoing Re-Do Ileal Pouch Anal Anastomosis

Esen

Grieco

Erkan

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND:The data on management and outcomes of pelvic sepsis after re-do IPAA are scarce. OBJECTIVE:The aim of this study is to report our management algorithm of pelvic sepsis in the setting of re-do IPAA and compare functional outcomes and quality of life after successful management of pelvic sepsis with a no sepsis control group.DESIGN: This is a retrospective cohort study. SETTINGS:This investigation is based on a single academic practice group experience on re-do IPAA. PATIENTS:Patients who underwent re-do IPAA for ileal pouch failure between September 2016 and September 2020 were included in the study. MAIN OUTCOME MEASURES:Management of pelvic sepsis was reported. Functional outcomes, restrictions, and quality-of-life scores were compared between the sepsis and no sepsis groups.RESULTS: One-hundred ten patients were included in our study, of whom 25 (22.7%) developed pelvic sepsis. Twenty-three patients presented with pelvic sepsis before ileostomy closure, and 2 patients presented with pelvic sepsis after ileostomy closure. There were 6 pouch failures in the study period due to pelvic sepsis. Our management was successful in 79% of the patients with median follow-up of 26 months. Treatments included interventional radiology abscess drainage (n = 7), IV antibiotics alone (n = 5), interventional radiology drainage and mushroom catheter placement (n = 1), mushroom catheter placement (n = 1), and endoluminal vacuumassisted closure (n = 1). Average number of bowel movements, urgency, incontinence, pad use, and seepage were comparable between the pelvic sepsis and no pelvic sepsis groups (p > 0.05). Lifestyle alterations, Cleveland Global Quality of Life scores, and happiness with the results of the surgery were similar (p > 0.05). LIMITATIONS:This study is limited by its low study power and limited follow-up time.CONCLUSIONS: Pelvic sepsis is common after re-do IPAA, and management varies according to the location and size of the abscess/sinus. If detected early, our management strategy was associated with high pouch salvage rates. See Video Abstract at http://links.lww.com/ DCR/B823. MANEJO, RESULTADOS FUNCIONALES Y CALIDAD DE VIDA DESPUÉS DEL DESARROLLO DE SEPSIS PÉLVICA EN PACIENTES SOMETIDAS A RECONFECCIÓN DE ANASTOMOSIS ANAL CON BOLSA ILEALFunding/Support: None reported.

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Indications, functional and quality of life outcomes of new pouch creation during re-do ileal pouch anal anastomosis: A comparative study with existing pouch salvage

Esen

Kirat

Erkan

et al. 2022

Surgery

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Transabdominal re-do pouch surgery in pediatric patients for failed ileal pouch anal anastomosis: a case matched study

Cited by 4 publications

References 28 publications

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

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

Management, Functional Outcomes, and Quality of Life After Development of Pelvic Sepsis in Patients Undergoing Re-Do Ileal Pouch Anal Anastomosis

Indications, functional and quality of life outcomes of new pouch creation during re-do ileal pouch anal anastomosis: A comparative study with existing pouch salvage

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