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



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.


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.


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.


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.


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


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.


  1. 1.
    Remzi FH, Aytac E, Ashburn J, Gu J, Hull TL, Dietz DW, Stocchi L, Church JM, Shen B (2015) Transabdominal redo ileal pouch surgery for failed restorative proctocolectomy: lessons learned over 500 patients. Ann Surg 262:675–682CrossRefGoogle Scholar
  2. 2.
    Joyce MR, Fazio VW (2009) Can ileal pouch anal anastomosis be used in Crohn’s disease? Adv Surg 43:111–137CrossRefGoogle Scholar
  3. 3.
    Melton GB, Fazio VW, Kiran RP, He J, Lavery IC, Shen B, Achkar JP, Church JM, Remzi FH (2008) Long-term outcomes with ileal pouch-anal anastomosis and Crohn’s disease: pouch retention and implications of delayed diagnosis. Ann Surg 248:608–616PubMedGoogle Scholar
  4. 4.
    Fazio VW, Kiran RP, Remzi FH, Coffey JC, Heneghan HM, Kirat HT, Manilich E, Shen B, Martin ST (2013) Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 257:679–685CrossRefGoogle Scholar
  5. 5.
    Siassi M, Weiger A, Hohenberger W, Kessler H (2007) Changes in surgical therapy for Crohn’s disease over 33 years: a prospective longitudinal study. Int J Color Dis 22:319–324CrossRefGoogle Scholar
  6. 6.
    Le Q, Melmed G, Dubinsky M et al (2013) Surgical outcome of ileal pouch-anal anastomosis when used intentionally for well-defined Crohn’s disease. Inflamm Bowel Dis 19:30–36CrossRefGoogle Scholar
  7. 7.
    Garrett KA, Remzi FH, Kirat HT, Fazio VW, Shen B, Kiran RP (2009) Outcome of salvage surgery for ileal pouches referred with a diagnosis of Crohn’s disease. Dis Colon Rectum 52:1967–1974CrossRefGoogle Scholar
  8. 8.
    Shen B, Patel S, Lian L (2010) Natural history of Crohn’s disease in patients who underwent intentional restorative proctocolectomy with ileal pouch-anal anastomosis. Aliment Pharmacol Ther 31:745–753CrossRefGoogle Scholar
  9. 9.
    Peyregne V, Francois Y, Gilly FN et al (2000) Outcome of ileal pouch after secondary diagnosis of Crohn’s disease. Int J Color Dis 15:49–53CrossRefGoogle Scholar
  10. 10.
    Shen B, Fazio VW, Remzi FH, Lashner BA (2005) Clinical approach to diseases of ileal pouch-anal anastomosis. Am J Gastroenterol 100:2796–2807CrossRefGoogle Scholar
  11. 11.
    Fazio VW, O'Riordain MG, Lavery IC et al (1999) Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 230:575–584 discussion 584-6CrossRefGoogle Scholar
  12. 12.
    Kiran RP, Delaney CP, Senagore AJ, O'Brien-Ermlich B, Mascha E, Thornton J, Fazio VW (2003) Prospective assessment of Cleveland Global Quality of Life (CGQL) as a novel marker of quality of life and disease activity in Crohn's disease. Am J Gastroenterol 98:1783–1789CrossRefGoogle Scholar
  13. 13.
    Shen B, Fazio VW, Remzi FH et al (2006) Risk factors for clinical phenotypes of Crohn’s disease of the ileal pouch. Am J Gastroenterol 101:2760–2768.10CrossRefGoogle Scholar

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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