Transabdominal Redo Ileal Pouch Surgery for Failed Restorative Proctocolectomy

TLDR

IPAA failure occurs in 3–15% of cases, mainly from technical or inflammatory issues, and there is limited data on the surgical, functional, and quality‑of‑life outcomes of redo IPAA, prompting this retrospective review of patients from 1983 to 2014. This study reports a large, single‑center experience of transabdominal ileal pouch‑anal anastomosis redo surgery for failed initial IPAA. The authors evaluated 502 patients (median age 38, 43% male) undergoing transabdominal redo IPAA between 1983 and 2014, assessing morbidity, pouch function, defecation frequency, incontinence, and quality‑of‑life outcomes. Among these patients, 41% received a new pouch and 59% had the original pouch revised; postoperative mortality was 0%, morbidity 53%, leak rate 8%, and 20% experienced pouch failure at a median 7‑year follow‑up, with pelvic sepsis being the strongest predictor, yet.

Abstract

The purpose of this study was to report our large, single-center experience of transabdominal ileal pouch-anal anastomoses (IPAA) redo surgery for a failed initial IPAA.IPAA fail from 3% to 15% of the times, mainly due to technical or inflammatory conditions. There is limited information about the surgical, functional, and quality-of-life (QOL) outcomes of redo surgery for failed IPAA, especially in large series of patients.Patients undergoing transabdominal redo surgery for failed IPAA between 1983 and 2014 were evaluated. Primary endpoints were morbidity of the surgery, the proportion of patients with a functioning pouch, frequency of defecation and incidence of incontinence, and the patients' perception of QOL.There were 502 (43% males) patients with a median age of 38 years and median body mass index 24 kg/m at the time of revision surgery. A new pouch was created in 41% of patients whereas 59% had their original pouch revised and retained. Postoperative mortality was 0% and morbidity was 53%. The short-term anastomotic leak rate was 8%. At a median follow-up of 7 years after redo surgery, 101 (n = 20%) patients had redo IPAA failure. Pelvic sepsis developing after redo ileal pouch surgery was the primary indicator of pouch failure (hazard ratio, 3.691; 95% confidence interval, 2.411-5.699; P < 0.0001). Overall functional outcomes and QOL scores were acceptable.Patients with a failed ileoanal pouch may be offered redo pouch surgery with a high likelihood of success in terms of function and QOL.