What is the Optimal Strategy for Pouch Salvage at the Time of Redo Ileal-Pouch Anal Anastomosis? Pouch Repair with Re-Anastomosis vs Pouch Excision with Neo-Pouch.
Journal
Journal of the American College of Surgeons
ISSN: 1879-1190
Titre abrégé: J Am Coll Surg
Pays: United States
ID NLM: 9431305
Informations de publication
Date de publication:
29 May 2024
29 May 2024
Historique:
medline:
30
5
2024
pubmed:
30
5
2024
entrez:
30
5
2024
Statut:
aheadofprint
Résumé
The long-term risk of pouch failure after restorative proctocolectomy with ileal-pouch anal anastomosis (IPAA) range from 5 and 15%. Salvage surgery for failing IPAA's may be achieved by disconnecting the IPAA and either repairing and re-using the existing pouch (REP) or constructing a neo-pouch (NEO). We aimed to evaluate whether there are differences in long-term functional pouch survival and functional outcomes between the REP group and the NEO group. We hypothesized patients undergoing REP have higher long-term pouch survival rates compared to patients who require NEO pouch construction. Our prospectively maintained Pouch Registry was queried for patients who underwent a pouch salvage surgery with either pouch REP or NEO from 1988 - 2020. Patients who underwent pouch repair without disconnection from the anus were excluded. The primary endpoint was long-term pouch survival after redo pouch surgery. Secondary outcomes were patient reported quality of life and pouch function. Of 653 patients undergoing redo IPAA, 462 met inclusion criteria of transabdominal redo surgery with pouch reconnection: 243 (52.6%) had REP and 219 (47.4%) had NEO. Median age was 39 years and 59% were female. Median time between index and redo IPAA was 34 months for REP vs 54 months for NEO (p=0.002). The 5-year pouch survival after redo IPAA was similar between REP (79.5%) and NEO (76.8%) groups (p=0.4). Fewer patients in the REP group reported nighttime pad use (51.4% vs 68.2%, p=0.04). Pouch survival and functional outcomes after salvage surgery for failing ileoanal pouch was similar regardless of pouch salvage procedure. When performing redo pouch surgery, surgeons should not hesitate to construct a new pouch if indicated.
Sections du résumé
BACKGROUND
BACKGROUND
The long-term risk of pouch failure after restorative proctocolectomy with ileal-pouch anal anastomosis (IPAA) range from 5 and 15%. Salvage surgery for failing IPAA's may be achieved by disconnecting the IPAA and either repairing and re-using the existing pouch (REP) or constructing a neo-pouch (NEO). We aimed to evaluate whether there are differences in long-term functional pouch survival and functional outcomes between the REP group and the NEO group. We hypothesized patients undergoing REP have higher long-term pouch survival rates compared to patients who require NEO pouch construction.
METHODS
METHODS
Our prospectively maintained Pouch Registry was queried for patients who underwent a pouch salvage surgery with either pouch REP or NEO from 1988 - 2020. Patients who underwent pouch repair without disconnection from the anus were excluded. The primary endpoint was long-term pouch survival after redo pouch surgery. Secondary outcomes were patient reported quality of life and pouch function.
RESULTS
RESULTS
Of 653 patients undergoing redo IPAA, 462 met inclusion criteria of transabdominal redo surgery with pouch reconnection: 243 (52.6%) had REP and 219 (47.4%) had NEO. Median age was 39 years and 59% were female. Median time between index and redo IPAA was 34 months for REP vs 54 months for NEO (p=0.002). The 5-year pouch survival after redo IPAA was similar between REP (79.5%) and NEO (76.8%) groups (p=0.4). Fewer patients in the REP group reported nighttime pad use (51.4% vs 68.2%, p=0.04).
CONCLUSION
CONCLUSIONS
Pouch survival and functional outcomes after salvage surgery for failing ileoanal pouch was similar regardless of pouch salvage procedure. When performing redo pouch surgery, surgeons should not hesitate to construct a new pouch if indicated.
Identifiants
pubmed: 38814287
doi: 10.1097/XCS.0000000000001122
pii: 00019464-990000000-00993
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.