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

Abstract

: Repeat abdominal surgery was a good alternative for pouch failure. Functional and quality of life outcomes were encouraging.

Ileal Pouch Prolapse: Prevalence, Management, and Outcomes

“…8 We insert ureteric stents and place the patient in a lithotomy position. The pelvic dissection should begin posteriorly after one has identified a plane between the sacral promontory and mesentery of the pouch.…”

Reoperative transabdominal surgery for ileoanal pouch salvage

“…5,11,13,14,15 The outcomes following redo IPAA surgery are critically dependent on experience and technical proficiency. 5,10,11,[14][15][16][17] Redo IPAA surgery provides acceptable function and good quality of life in patients who would deemed to have a permanent ileostomy, while seepage and pad usage requirement his relatively high after ileoanal pouch salvage. 10,11 Our patients had daytime and nighttime stool frequencies 6 (1-15) and 2 (0-9), respectively, and approximately 50% of patients had seepage and used pads by day and night.…”

“…All over the world limited number of institutions have adequate experience, infrastructure and case volume on redo IPAA surgery. 5,10 …”

“…2 Around one/tenth of ileoanal pouches fail in longterm due to septic, mechanic, functional or biologic complications. [3][4][5][6][7] Primary diagnosis (ie Crohn's disease), development of anal pathology, anal sphincter dysfunction, patient comorbidities (ie weight gain), pelvic sepsis, anastomotic stricture and separation were found as predictors of pouch failure. 8,9 Pouch failure is a big tragedy for patients and some patients want to push the limits to salvage ileoanal pouch to avoid a permanent ileostomy.…”

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

“…[32][33][34][35][36][37][38] Success rates after salvage for OO complications range between 30 and 100%. 12,22,26,30,39 Subsequent malfunctioning is more frequently associated with redo pouch compared with preservation and revision of the former reservoir. 19 The decision whether to redo or preserve the reservoir usually depends on compliance due to fibrosis and adequate pouch volume.…”