RESULTS OF REVISIONAL SURGERY IN IPAA FOR ULCERATIVE COLITIS IN A MEDIUM-VOLUME CENTER
Eugenio Grasset*1,2, Leonardo Cárcamo1,3, Álvaro Zúñiga1, Gonzalo Urrejola1, Rodrigo Migueles1, Maria Molina1, Jose T. Larach1, Felipe Bellolio1
1Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile; 2Surgery, Universidad de Chile, Santiago, Chile; 3Surgery, Universidad Austral de Chile, Valdivia, Chile
Introduction
The ileoanal pouch anal anastomosis (IPAA) is the technique of choice in the surgical treatment of ulcerative colitis (UC). It is a complex procedure with complications in the short and long term that may require reinterventions in order to preserve the pouch or remove it depending on the condition.
Objective
Describe the characteristics and results of our experience in revisional surgery after IPAA.
Methods
Series of cases submitted to surgery because of malfunction of the pouch in our hospital from January 1989 to May 2018. We included all the patients who were revised in our center no matter where the reservoir was originally made. We describe demographic data, original surgical indication, survival of the pouch, diagnosis that motivates revision, types of procedures performed and success in the preservation of the reservoir. Descriptive statistics is used.
Results
We included 21 consecutive patients, with a median age of 39 (IQR: 31-52) years at the time of surgery, 8 where men. All were originally operated on for ulcerative colitis with poor response to medical treatment. The median survival of the reservoirs was 6 (IQR: 3.5-8.5) years. Of the 21 patients, 14 required removal of the pouch. The main causes of resection were sepsis in 8 and pouch-vaginal fistula in 4. Seven pouches were rescued, in 4 of them the cause of reoperation was efferent obstruction, 2 afferent obstruction and 1 prolapse.
Conclusion
In this series, sepsis is associated with loss of the pouch in revisional surgery, while outflow obstruction allows the reservoir to be preserved.
Back to 2019 Posters
