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International Journal of Colorectal Disease

, Volume 34, Issue 11, pp 1945–1951 | Cite as

Comparison of long-term outcomes of primary and redo IPAA for patients with Crohn’s disease

  • Olga A. Lavryk
  • Tracy L. HullEmail author
Original Article
  • 16 Downloads

Abstract

Background

Crohn’s disease (CD) patients after ileal anal pouch anastomosis (IPAA) are subject to CD recurrence, septic complications, and pouch failure. The aim of this study was to compare long-term outcomes of index and redo IPAA for CD.

Methods

Patients who underwent index and redo IPAA with a diagnosis of CD colitis were identified from a prospectively maintained IPAA database. Charts were reviewed to determine complications and pouch failure rates after index and redo IPAA. Long-term pouch survival and quality of life (QoL) were compared between index and redo IPAAs.

Results

There were 305 patients, 253 with an index IPAA and 52 having a redo IPAA. Their median ages were 33 years (index IPAA) and 32 years (redo IPAA) (p = 0.91); there were 47% and 53% men in each group, respectively (p = 0.54). Pouch salvage with redo IPAA was possible in 75% of redo pouches. Biologic agents were given in 8% of index IPAA and 34% redo IPAA patients (p < 0.01). Cumulative Kaplan Meier 5-year pouch survival was 80% vs. 60% in index and redo IPAA (p < 0.0001), at 10 years 74% vs. 38%, respectively (p < 0.0001). When queried, 78% who underwent redo pouch surgery would have it again and 86% would recommend this surgery to others.

Conclusion

IPAA can be offered to selected patients with isolated colonic CD. Failure in this group of patients is related mainly to recurrent CD, not surgical complications. Redo IPAA is a realistic option for salvage in certain patients with failed index IPAA.

Keywords

Ileal pouch anal anastomosis Familial adenomatous polyposis Pelvic pouch mucosa Crohn’s disease 

Notes

Author contribution

All authors participated in conception and design of the study, acquisition of data, analysis and interpretation of data, drafting and revising the manuscript, and approval of the published version.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Colorectal SurgeryDigestive Disease and Surgery Institute, Cleveland ClinicClevelandUSA

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