Repeat Ileal Pouch-Anal Anastomosis to Salvage Septic Complications of Pelvic Pouches

Abstract

Repeat IPAA can often salvage pelvic pouches in patients with MUC who suffer major chronic perianastomotic and pelvic sepsis. Patients who had successful repeat IPAA surgery often report functional problems but would still choose to have the surgery again. For patients with CD, ultimate pouch excision or fecal diversion have been required in 40% indicating a guarded prognosis for these patients. Data on the success of the procedure for patients with indeterminate colitis and familial adenomatous polyposis were inconclusive because of small sample sizes.

Repeat Pouch Surgery by the Abdominal Approach Safely Salvages Failed Ileal Pelvic Pouch

“…a guarded prognosis for patients with CD, as pouch excision or fecal diversion was required in 40 percent of patients with CD. 15 In the present study, 7 of 31 patients with CD (22.6 percent) experienced pouch failure. Coexisting sepsis with failed IPAA appears to be responsible for pouch failure after salvage procedures.…”

Salvage surgery after restorative proctocolectomy

“…fistulation 63 , including 22 with ulcerative colitis, ten with Crohn's disease, one with indeterminate colitis and two with FAP; 29 had leakage from the ileoanal anastomosis and four from the upper pouch. Overall a pelvic abscess was present in 25 patients, and ten had a vaginal and 12 a perineal fistula.…”

“…Abdominal salvage involves mobilization of the reservoir from the pelvis, followed by excision of the stenosis and reanastomosis of the apex of the reservoir to the distal anal canal. It is usually necessary to perform a mucosectomy to achieve this 63,87 . Technical details of importance include the need to dissect close to the reservoir to avoid damage to pelvic structures, including autonomic nerves, and removal of as much of the fibrosis as possible in the area of stricturing.…”

Outcomes of Salvage Surgery for Ileal Pouch Complications and Dysfunctions. The Experience of a Referral Centre and Review of Literature

“…For a small-volume reservoir, abdominal pouch salvage with pouch enlargement can reduce bowel frequency and rescue the pouch. 21 Fazio et al 21 successfully enlarged the reservoir of seven out of 35 patients who had pelvic sepsis causing pouch stiffness. Similar results are reported in patients with a small-volume pouch resulting from perioperative septic complications, in whom S-and J-shaped reservoirs were rearranged to form a W-pouch.…”