• J. Am. Coll. Surg. · Nov 2024

    Comparative Study

    What is the Optimal Strategy for Pouch Salvage at the Time of Redo Ileal-Pouch Anal Anastomosis? Pouch Repair with Re-Anastomosis vs Pouch Excision with Neo-Pouch.

    • Tairin Uchino, Marianna Maspero, Ali Alipouriani, Hernandez DominguezOscarO, Stefan D Holubar, Emre Gorgun, Scott R Steele, and Tracy L Hull.
    • From the Department of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH.
    • J. Am. Coll. Surg. 2024 Nov 1; 239 (5): 463470463-470.

    BackgroundThe long-term risk of pouch failure after restorative proctocolectomy with ileal-pouch anal anastomosis (IPAA) range from 5% to 15%. Salvage surgery for failing IPAA may be achieved by disconnecting the IPAA and either repairing and reusing the existing pouch (REP) or constructing a neopouch (NEO). We aimed to evaluate whether there are differences in long-term functional pouch survival and functional outcomes between the REP group and the NEO group. We hypothesized that patients undergoing REP have higher long-term pouch survival rates compared with patients who require NEO pouch construction.Study DesignOur prospectively maintained Pouch Registry was queried for patients who underwent a pouch salvage surgery with either pouch REP or NEO from 1988 to 2020. Patients who underwent pouch repair without disconnection from the anus were excluded. The primary endpoint was long-term pouch survival after redo pouch surgery. Secondary outcomes were patient-reported quality of life and pouch function.ResultsOf 653 patients undergoing redo IPAA, 462 met inclusion criteria of transabdominal redo surgery with pouch reconnection: 243 (52.6%) had REP and 219 (47.4%) had NEO. Median age was 39 years and 59% were women. Median time between index and redo IPAA was 34 months for REP vs 54 months for NEO (p = 0.002). The 5-year pouch survival after redo IPAA was similar between REP (79.5%) and NEO (76.8%) groups (p = 0.4). Fewer patients in the REP group reported nighttime pad use (51.4% vs 68.2%, p = 0.04).ConclusionsPouch survival and functional outcomes after salvage surgery for failing ileoanal pouch was similar regardless of pouch salvage procedure. When performing redo pouch surgery, surgeons should not hesitate to construct a new pouch if indicated.Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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