Abstracts
1998 Digestive Disease Week

#2334

ILEAL POUCH SALVAGE FOLLOWING FAILED ILEAL POUCH-ANAL ANASTOMOSIS. S. Saltzberg, C. DiEdwardo, T. Scott, and W. LaMorte, J. M. Becker, Department of Surgery, Boston University School of Medicine, Boston, MA.

Colectomy with ileal pouch-anal anastomosis (IPAA) has become a major surgical alternative for patients with chronic ulcerative colitis and familial polyposis coli. The operation avoids a permanent ileostomy, and in most patients preserves an excellent functional result. However, this remains a complex procedure associated with mechanical complications potentially resulting in pouch failure. Attempts have been made to salvage failed pouches through the use of three revisional approaches: partial transabdominal, partial transperineal, or total reconstruction of the IPAA. The aims of our study were to compare the overall success of the three approaches to pouch salvage and to assess the functional results and patient satisfaction among those with successful salvage operations.

Methods: Prospective data were obtained from 30 patients referred to our institution for salvage procedures for failed IPAA. Pouch salvage was defined as a procedure performed on the ileal pouchanal anastomosis or the pouch itself, and overall success was measured by the ultimate rate of conversion to permanent ileostomy. Functional outcomes and patient satisfaction were acquired by patient self-report.

Results: Over the mean of 2.5 years of follow-up (range 0.02-11.4), 18 out of 30 salvage attempts were successful, 11 out of 30 salvage attempts failed, and 1 out of 30 patients was lost to follow-up. The total reconstruction group had a success rate of 100%, compared to 22% in the partial transabdominal group, and 55% in the partial transperineal group (p=0.002). In patients undergoing total reconstruction (n=10) functional outcome, as measured by incontinence, improved with 43% reporting incontinence preoperatively compared to 0% postoperatively (p=0.06). Mean 24-hour stool frequency declined from 13.9 ± 2.8 to 8.7 ± 1.1 and mean nightime stool frequency was reduced from 4.7 ± 1.9 to 1.9 ± 0.5. All patients reported overall satisfaction with the functional results of the total reconstruction surgery.

Conclusion: 60% of patients who underwent ileal pouch salvage following IPAA have been successful in avoiding permanent ileostomy. Of the three salvage techniques, total reconstruction of the IPAA appears far more effective than either the partial transabdominal or partial transperineal procedures. These results suggest that a continued effort to salvage failed IPAA, particularly with total reconstruction, is a viable alternative to permanent ileostomy.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.