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Trans-Abdominal Redo Ileal Pouch Surgery For Failed Restorative Proctocolectomy Lessons Learned Over 500 Patients
Feza H Remzi*, Erman Aytac*, Jean Ashburn*, Jinyu Gu*, Tracy L Hull*, David W Dietz*, Luca Stocchi*, James M Church, Bo Shen*
Cleveland Clinic, Cleveland, OH

OBJECTIVE(S):Reported ileal pouch-anal anastomosis (IPAA) failure rate ranged from 3 to 15%, mainly due technical or inflammatory conditions.Surgical revision is the only option for patients with a failed IPAA to avoid permanent stoma.Data regarding surgical, functional and quality of life (QOL) outcomes of redo surgery for failed IPAA are limited.We aimed to evaluate single center experience on trans-abdominal redo surgery for failed IPAA.
METHODS: Patients undergoing trans-abdominal redo surgery for failed IPAA between 1983and2014 were evaluated based on prospectively maintained institutional registry.
RESULTS: There were 502(43% male) patients with a mean age of 38 and body mass index30kg/m2 at the time of revision surgery.407patients(81%) were referred from outside institutions.Operative indications are listed in the table.Prior pouch types were J(81%),S(18%)andW(0.3 %).The new pouch was created in 40% of patients.Of these patients with neo-IPAA, there were J(87%) and S(13%) pouches.Short-term anastomotic leak was 8%.The mean postoperative length of stay was 10 days.Failure rate after redo ileal pouch surgery was 19 % within a mean of 9 years follow-up.Overall functional outcomes and QOL scores were similar to that in patients who had had the first time IPAA.Patients with final diagnosis of Crohn’s disease,pouch vaginal fistula had high failure rates where septic complication as primary indication had higher success rates.
CONCLUSIONS: Redo ileal pouch surgery provides high salvage sates, avoids permanent stoma with acceptable functional outcome and QOL.
Indications of redo surgery
n=502
Septic complications
Anastomotic leak/fistula/anastomotic sinus/pelvicor perianal abscess
305 (61 %)
Obstruction/prolapse125 (25 %)
Dysfunction / chronic pouchitis60 (12 %)
Neoplasia12 (2 %)


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