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

Christopher Mascarenhas; Scott R. Steele; Tracy Hull

Disclosures

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

In This Article

Outcomes

As evidenced in Table 5, re-do pouch surgery has acceptable outcomes. In the largest study to date involving over 502 people over 38 years, there was 0% mortality, an 8% short-term anastomotic leak rate, and an overall morbidity rate of 53%. At a median follow-up of 7 years,

80% of patients had a successfully functioning re-do pouch.[6] Other more recent literature reports success rates of acceptable pouch function between 65 and 90% for re-do pouches. All results are influenced by length of follow-up and diagnosis of Crohn's disease.[7,8,17] It is important to remember that early sepsis following initial pouch construction is typically not Crohn's disease. Garrett and Remzi[18] found that 78% of patients referred with a diagnosis of Crohn's disease had their diagnosis changed to a technical complication of IBD after careful work-up. When evaluating patients, those that truly have Crohn's disease may require long-term medications. Mathis et al.,[19] found that 8 of 11 patients with Crohn's disease undergoing re-do pouches had complete or partial therapeutic response to treatment with infliximab. For patients in whom re-do pouches fail, if they have adequate sphincter function a repeat re-do pouch can be considered. Some patients are not candidates for a re-re-do pouch because of inadequate sphincter function or severe pelvic fibrosis. In this group, a continent ileostomy (i.e. Koch pouch) may be considered and has been found to be successful in up to 84% of patients at 5 years.[20]

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