OUTCOMES OF REDO ILEAL POUCH ANAL ANASTOMOSIS FOR EARLY VERSUS LATE SEPSIS-RELATED POUCH FAILURE
Marianna Maspero*, Olga Lavryk, Jeremy M. Lipman, Michael Valente, Hermann Kessler, Stefan D. Holubar, Scott Steele, Tracy L. Hull
Cleveland Clinic, Cleveland, OH
Background: Pouch failure after restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) occurs in up to 15% of cases, mostly due to septic complications. We aimed to determine if the timing of pouch failure impacted long-term outcomes for redo IPAA after sepsis-related complications. We hypothesized that late pouch failure would be associated with worsened outcomes.
Methods: Patients who underwent redo IPAA for septic complications between 1988 and 2020 were included in the analysis. The cohort was divided in an early (diagnosis of pouch failure within 6 months of stoma closure after index operation, or stoma never closed) and a late failure group (diagnosis of pouch failure after 6 months of stoma closure). The primary endpoint of the study was avoidance of permanent ileostomy.
Results: In total, 335 patients were included: 241 (72%) in the early and 94 (28%) in the late failure group. The median interval between index IPAA and redo was 23 (IQR 15 – 37) months for the early and 100 (67 – 154) months for the late failure group (p < 0.001). The most common indication for failure was anastomotic leak in the early failure group (163, 68%) and fistula in the late failure group (59, 63%), p < 0.001. Most patients in both groups underwent pouch excision with neo-pouch creation (141, 59%, in the early, and 64, 68% in the late failure group, p 0.13), while the others kept their original pouch but had a new IPAA. After redo IPAA, 89% of patients in the early and 93% in the late failure group had their diverting loop ileostomy closed. After a median follow up of 55 (21 – 115.5) months for the early and 54 (19 – 97) months for the late failure group, the number of patients with a permanent ileostomy was 60 (25%) in the early and 22 (23%) in the late failure group. Pouch survival at 3-, 5-, and 10-years was 77%, 75%, and 72% for the early, and 79%, 75%, and 68% for the late failure group (p = 0.94). The most common reason for redo pouch failure was fistula in both groups. The median interval between redo IPAA and permanent ileostomy was 39 (12.5 – 101.5) months for the early and 42 (12 – 81) months for the late failure group. Quality of life indicators after redo IPAA were similarly good in both groups, with a median quality of life score of 8 (6 – 9) for the early and 8 (5 – 9) for the late failure group.
Conclusion: Outcomes after redo IPAA were comparable between patients with early and late sepsis-related index pouch failure, with acceptable rates of long-term pouch survival and good quality of life.
Figure 1. Kaplan Meier curve of pouch survival after redo ileoanal pouch for early versus late sepsis-related index pouch failure
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