Abstract
PURPOSE: Complications of the ileal pouch with ileoanal anastomosis are associated with poor function and diminished quality of life; often, these complications may require surgery to salvage the pouch. The aims of this study were to review our experience with reoperative ileoanal pouch surgery and to define any predictors of pouch salvage surgery. METHODS: Between 1991 and 1999, the medical records of all patients who underwent reoperative ileoanal pouch surgery for either pouch salvage or pouch excision were reviewed; any minor local procedures were excluded. Successful ileoanal pouch salvage was considered to be an intact and functioning pouch, with acceptable patient satisfaction and good control. RESULTS: Thirty-two patients underwent reoperative ileoanal pouch surgery, 25 for attempted pouch salvage and 10 for pouch excision (3 patients were included in both groups). Five patients (20 percent) had pouch reconstruction, 1 of which was successful; 8 (32 percent) had pouch advancement, with a 62 percent success rate; and 16 (64 percent) had local perianal procedures for control of perianal sepsis, with a 75 percent success rate (4 of these required further surgery). The overall success rate of ileoanal pouch salvage surgery was 84 percent, with 64 percent of patients having acceptable function. There was no correlation between the number of ileoanal pouch salvage procedures and failure. Four (40 percent) of the 10 patients who had pouch excision were ultimately diagnosed with Crohn's disease. CONCLUSIONS: Ileoanal pouch salvage surgery is often successful and, in motivated patients without Crohn's disease, is worthwhile. Pouch advancement or local perianal repair yielded better results than did pouch reconstruction. Patients diagnosed with Crohn's disease after ileoanal pouch construction may be best suited for pouch excision when complications occur.
Similar content being viewed by others
References
Belliveau P, Trudel J, Vasilevsky CA, Stein B, Gordon PH. Ileoanal anastomosis with reservoirs: complications and long-term results. Can J Surg 1999;42:345–452.
Thompson-Fawcett MW, Jewell DP, Mortensen NJ. Ileoanal reservoir dysfunction: a problem-solving approach. Br J Surg 1997;84:1351–9.
Marcello PW, Roberts PL, Schoetz DJ Jr, Coller JA, Murray JJ, Veidenheimer MC. Long-term results of the ileoanal pouch procedure. Arch Surg 1993;128:500–3.
Dayton MT, Larsen KP. Outcome of pouch-related complications after ileal pouch-anal anastomosis. Am J Surg 1997;174:728–31.
Korsgen S, Keighley MR. Causes of failure and life expectancy of the ileoanal pouch. Int J Colorectal Dis 1997;12:4–8.
MacRae HM, McLeod RS, Cohen Z, O'Connor BI, Ton EN. Risk factors for pelvic pouch failure. Dis Colon Rectum 1997;40:257–62.
Seidel SA, Peach SE, Newman M, Sharp KW. Ileoanal pouch procedures: clinical outcomes and quality-of-life assessment. Am Surg 1999;65:40–6.
Fazio VW, O'Riordain MG, Lavery IC,et al. Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 1999;230:575–84.
Awad RW, el-Gohary TM, Skilton JS, Elder JB. Life quality and psychological morbidity with an ileostomy. Br J Surg 1993;80:252–3.
Poggioli G, Marchetti F, Selleri S, Laureti S, Stocchi L, Gozzetti G. Redo pouches: salvaging of failed ileal pouch-anal anastomoses. Dis Colon Rectum 1993;36:492–6.
Sagar PM, Dozois RR, Wolff BG, Kelly KA. Disconnection, pouch revision and reconnection of the ileal pouch-anal anastomosis. Br J Surg 1996;83:1401–5.
Herbst F, Sielezneff I, Nicholls RJ. Salvage surgery for ileal pouch outlet obstruction. Br J Surg 1996;83:368–71.
Ogunbiyi OA, Korsgen S, Keighley MR. Pouch salvage: long-term outcome. Dis Colon Rectum 1997;40:548–52.
Fazio VW, Wu JS, Lavery IC. Repeat ileal pouch-anal anastomosis to salvage septic complications of pelvic pouches: clinical outcome and quality of life assessment. Ann Surg 1998;228:588–97.
Cohen Z, Smith D, McLeod R. Reconstructive surgery for pelvic pouches. World J Surg 1998;22:342–6.
Fonkalsrud EW, Bustorff-Silva J. Reconstruction for chronic dysfunction of ileoanal pouches. Ann Surg 1999;229:197–204.
Saltzberg SS, DiEdwardo C, Scott TE, LaMorte WW, Stucchi AF, Becker JM. Ileal pouch salvage following failed ileal pouch-anal anastomosis. J Gastrointest Surg 1999;3:633–41.
Marcello PW, Schoetz DJ Jr, Roberts PL,et al. Evolutionary changes in the pathologic diagnosis after the ileoanal pouch procedure. Dis Colon Rectum 1997;40:263–9.
Keighley MR, Grobler S, Bain I. An audit of restorative proctocolectomy. Gut 1993;34:680–4.
Gemlo BT, Wong WD, Rothenberger DA, Goldberg SM. Ileal pouch-anal anastomosis: patterns of failure. Arch Surg 1992;127:784–6.
Author information
Authors and Affiliations
Additional information
Funded in part by an educational grant from the Eleanor Naylor Dana Charitable Trust Fund.
About this article
Cite this article
Zmora, O., Efron, J.E., Nogueras, J.J. et al. Reoperative abdominal and perineal surgery in ileoanal pouch patients. Dis Colon Rectum 44, 1310–1314 (2001). https://doi.org/10.1007/BF02234789
Issue Date:
DOI: https://doi.org/10.1007/BF02234789