Transabdominal redo ileal pouch surgery for failed restorative proctocolectomy: Lessons learned over 500 patients

Remzi F. H., Aytac E., Ashburn J., Gu J., Hull T. L., Dietz D. W., ...More

Annals of Surgery, vol.262, pp.675-682, 2015 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Abstract
  • Volume: 262
  • Publication Date: 2015
  • Doi Number: 10.1097/sla.0000000000001386
  • Journal Name: Annals of Surgery
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.675-682
  • Keywords: ileal pouch, ileal pouch-anal anastomosis, redo, repeat, transabdominal, QUALITY-OF-LIFE, ANAL ANASTOMOSIS, RECONSTRUCTIVE SURGERY, ULCERATIVE-COLITIS, COMPLICATIONS, SALVAGE, OUTCOMES
  • Acibadem Mehmet Ali Aydinlar University Affiliated: Yes


Objectives: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.Background: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.Methods: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.Results:There were 502 (43% males) patients with a median age of 38 years and median body mass index 24 kg/m(2) 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.Conclusions:Patients with a failed ileoanal pouch may be offered redo pouch surgery with a high likelihood of success in terms of function and QOL.