Results of Surgical Removal of the Pouch After Failed Restorative Proctocolectomy

Abstract

Pouch excision is associated with high morbidity. Perineal wound-delayed healing is the commonest late complication and often requires further surgery.

Causes and outcomes of pouch excision after restorative proctocolectomy

“…In the present study complete excision of the anal sphincters at the time of pouch excision produced better immediate results in patients with Crohn's disease and recurrent sepsis. In contrast, in other series the extent of sphincteric resection did not have an influence on perineal healing after pouch excision 14 or proctectomy for Crohn's disease 30 .…”

“…There is, however, comparatively little in the literature regarding the underlying causes of pouch failure and the outcome for these patients 3,5,12 -14 . Only one paper has addressed the issue of perineal wound healing after pouch excision 14 . The aims of the present study were to determine the reasons for pouch excision after IPAA and to evaluate the outcome of the perineal wound after pouch excision.…”

The failed pelvic pouch: conversion to a continent ileostomy

“…Various methods of managing perineal tissue have been employed for prevention of postoperative abscess and suppuration [19], but the results are unconvincing. Recent evidence shows that pelvic pouch excision is associated with a high rate of perineal sepsis [20]. The most common cause for the pelvic pouch failure in the present series of patients was a pouch-anal fistula, a reasonable explanation for the frequent occurrence of postoperative perineal wound suppuration.…”

Factors affecting the healing of the perineum following surgery

“…[9][10][11] The rate of PPS for patients who underwent pouch excision has been reported as 40% at 6 months and 10% at 12 months. 12 Despite recent advances in surgical techniques and perineal wound management, there has not been significant improvement in perineal wound healing. 4 The aims of this study were to provide contemporary data on patient and procedural factors associated with the development of the unhealed perineum and subsequent perineal wound healing following surgery, and to determine the healing rate of patients with an unhealed perineum up to 12 months postoperatively.…”