Causes and outcomes of pouch excision after restorative proctocolectomy

TLDR

Pouch failure occurs in up to 10 % of patients after ileal pouch‑anal anastomosis. This study aimed to identify the causes of pouch excision and assess perineal wound healing following excision. A retrospective analysis of prospectively collected data from 24 patients who underwent pouch excision, grouped by final histology, was performed. Sepsis—often linked to recurrent Crohn’s disease—was the leading indication for excision, with 14 Crohn’s patients and 6 persistent perineal sinuses, while desmoid tumors, recurrent pelvic sepsis, and cancer also contributed; perineal wound healing remained problematic, especially after Crohn’s disease excisions.

Abstract

Pouch failure occurs in up to 10 per cent of patients after ileal pouch-anal anastomosis (IPAA). The aims of this study were to determine the reasons for pouch excision and to evaluate the outcome of the perineal wound after pouch excision.Between 1984 and 2002, 91 patients with severe ileal pouch dysfunction were treated. This was a retrospective analysis of data collected prospectively from 24 patients who underwent pouch excision.Patients were grouped according to the final histological diagnosis. Fourteen patients with Crohn's disease developed extensive fistulous disease and/or recurrent abscesses, of whom six had a persistent perineal sinus after pouch excision. Five patients had familial adenomatous polyposis, in three of whom desmoid tumours were the cause of failure. Three patients had chronic ulcerative colitis and developed recurrent pelvic sepsis. Finally, two patients with multiple colorectal adenocarcinoma developed recurrent cancer (one) or sepsis (one).Sepsis was the principal reason for pouch excision and was usually associated with recrudescent Crohn's disease in the pouch. Perineal wound healing was problematic after pouch excision for Crohn's disease.