The ABC's of Re-do Ileoanal Pouches, What Every Gastroenterologist Should Know

Christopher Mascarenhas; Scott R. Steele; Tracy Hull


Curr Opin Gastroenterol. 2019;35(4):321-329. 

In This Article

Evaluation and Work-up of the Failing Pouch and When to Refer Patients

As with any complex surgical procedure, there can be complications and even failure. In the Cleveland Clinic experience, short-term morbidity after an IPAA ranged from 28 to 58%, with a long-term failure rate was up to 15%.[5] Successful pouch surgery has been described as a patient reporting fewer than 12 bowel movements a day with good control of both solid and liquid stool after at least 6 months of follow-up. They should also have patient satisfaction scores reported as excellent or good in quality-of-life evaluation.[6] Pouch failure is defined as the need for construction of an indefinite defunctioning stoma in the presence of an IPAA, or excision of the pouch because of complications.[5,7] Table 1 describes scenarios when one should consider referring a patient for a pouch removal versus a revision or re-do.