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Failing Pouch

  • Hasan T. Kirat
  • Feza H. Remzi
Chapter

Abstract

Restorative proctocolectomy with ileal pouch-anal anastomosis (RP/IPAA) is the procedure of choice for patients with ulcerative colitis and selected patients with familial adenomatous polyposis [1, 2] (Fig. 20.1). J-pouch is the most commonly used reservoir because it is easier to construct compared with S or W pouches [2] (Fig. 20.2). Stapled IPAA has become the preferred approach with good long-term functional outcomes and quality of life (QOL) over a hand-sewn anastomosis [3] (Fig. 20.3). In patients with toxic megacolon or severe fulminant colitis, RP/IPAA is performed in multistages including subtotal colectomy and end ileostomy and then in about 6 months completion proctectomy and IPAA with/without diverting ileostomy. Ileostomy is closed in 3 months following IPAA after checking integrity of pouch and IPAA using water-contrasted enema.

Keywords

Familial Adenomatous Polyposis Restorative Proctocolectomy Pelvic Sepsis Pouch Failure Reoperative Surgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. Br Med J. 1978;2:85–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Fazio VW, O’Riordain MG, Lavery IC, et al. Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg. 1999;230:575–84; discussion 584–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Kirat HT, Remzi FH, Kiran RP, Fazio VW. Comparison of outcomes after hand-sewn versus stapled ileal pouch-anal anastomosis in 3,109 patients. Surgery. 2009;146:723–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Hueting WE, Buskens E, van der Tweel I, Gooszen HG, van Laarhoven CJ. Results and complications after ileal pouch anal anastomosis: a meta-analysis of 43 observational studies comprising 9,317 patients. Dig Surg. 2005;22:69–79.PubMedCrossRefGoogle Scholar
  5. 5.
    Fazio VW, Tekkis PP, Remzi F, Lavery IC, Manilich E, Connor J, Preen M, Delaney CP. Quantification of risk for pouch failure after ileal pouch anal anastomosis surgery. Ann Surg. 2003;238:605–14; discussion 614–7.PubMedGoogle Scholar
  6. 6.
    Dehni N, Remacle G, Dozois RR, Banchini F, Tiret E, Parc R. Salvage reoperation for complications after ileal pouch-anal anastomosis. Br J Surg. 2005;92:748–53.PubMedCrossRefGoogle Scholar
  7. 7.
    Shawki S, Belizon A, Person B, Weiss EG, Sands DR, Wexner SD. What are the outcomes of reoperative restorative proctocolectomy and ileal pouch-anal anastomosis surgery? Dis Colon Rectum. 2009;52:884–90.PubMedCrossRefGoogle Scholar
  8. 8.
    Shah NS, Remzi FH, Massmann A, Baixauli J, Fazio VW. Management and treatment outcome of pouch-vaginal fistulas following restorative proctocolectomy. Dis Colon Rectum. 2003;46:911–7.PubMedCrossRefGoogle Scholar
  9. 9.
    MacLean AR, O’Connor B, Parkes R, Cohen Z, McLeod RS. Reconstructive surgery for failed ileal pouch-anal anastomosis: a viable surgical option with acceptable results. Dis Colon Rectum. 2002;45:880–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Fonkalsrud EW, Bustorff-Silva J. Reconstruction for chronic dysfunction of ileoanal pouches. Ann Surg. 1999;229:197–204.PubMedCrossRefGoogle Scholar
  11. 11.
    Fazio VW, Wu JS, Lavery IC. Repeat ileal pouch-anal anastomosis to salvage septic complications of pelvic pouches: clinical outcome and quality of life assessment. Ann Surg. 1998;228:588–97.PubMedCrossRefGoogle Scholar
  12. 12.
    Baixauli J, Delaney CP, Wu JS, Remzi FH, Lavery IC, Fazio VW. Functional outcome and quality of life after repeat ileal pouch-anal anastomosis for complications of ileoanal surgery. Dis Colon Rectum. 2004;47:2–11.PubMedCrossRefGoogle Scholar
  13. 13.
    Mathis KL, Dozois EJ, Larson DW, Cima RR, Wolff BG, Pemberton JH. Outcomes in patients with ulcerative colitis undergoing partial or complete reconstructive surgery for failing ileal pouch-anal anastomosis. Ann Surg. 2009;249:409–13.PubMedCrossRefGoogle Scholar
  14. 14.
    Tekkis PP, Heriot AG, Smith JJ, Das P, Canero A, Nicholls RJ. Long-term results of abdominal salvage surgery following restorative proctocolectomy. Br J Surg. 2006;93:231–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Remzi FH, Fazio VW, Kirat HT, Wu JS, Lavery IC, Kiran RP. Repeat pouch surgery by the abdominal approach safely salvages failed ileal pelvic pouch. Dis Colon Rectum. 2009;52:198–204.PubMedCrossRefGoogle Scholar
  16. 16.
    Garrett KA, Remzi FH, Kirat HT, Fazio VW, Shen B, Kiran RP. Outcome of salvage surgery for ileal pouches referred with a diagnosis of Crohn’s disease. Dis Colon Rectum. 2009;52:1967–74.PubMedCrossRefGoogle Scholar
  17. 17.
    Kirat HT, Kiran RP, Oncel M, Shen B, Fazio VW, Remzi FH. Management of leak from the tip of the “j” in ileal pouch-anal anastomosis. Dis Colon Rectum. 2011;54:454–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Tan HT, Morton D, Connolly AB, Pringle W, White M, Keighley MR. Quality of life after pouch excision. Br J Surg. 1998;85:249–51.PubMedCrossRefGoogle Scholar
  19. 19.
    Lepistö A, Luukkonen P, Järvinen HJ. Cumulative failure rate of ileal pouch-anal anastomosis and quality of life after failure. Dis Colon Rectum. 2002;45:1289–94.PubMedCrossRefGoogle Scholar
  20. 20.
    Das P, Smith JJ, Tekkis PP, Heriot AG, Antropoli M, John Nicholls R. Quality of life after indefinite diversion/pouch excision in ileal pouch failure patients. Colorectal Dis. 2007;9:718–24.PubMedCrossRefGoogle Scholar
  21. 21.
    Bengtsson J, Börjesson L, Willén R, Oresland T, Hultén L. Can a failed ileal pouch anal anastomosis be left in situ? Colorectal Dis. 2007;9:503–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2012

Authors and Affiliations

  1. 1.Department of Colorectal SurgeryCleveland Clinic FoundationClevelandUSA

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