Colorectal Dis. 2022 Jan 24. doi: 10.1111/codi.16064. Online ahead of print.
ABSTRACT
AIM: To evaluate surgical strategies for conversion of failed ileo-pouch-anal anastomosis (IPAA) to continent ileostomy (CI), taking morbidity and overall outcome into account. The hypothesis is that complex conversions are equivalent to the primary construction of a CI at the time of proctocolectomy.
METHOD: Retrospective analysis of IPAA conversions acknowledging the underlying disease (inflammatory bowel disease (IBD), and non-IBD) and extent of pouch-reconstruction (PR). Type 1 (without PR): n=13, Type 2 (partial PR): n=7, and Type 3 (complete PR): n=6.
RESULTS: 26 patients (IBD: n=16; non-IBD: n=10) were converted (type 1: n=13; type 2: n=7 and type 3: n=6).12/26 patients (46.2%) presented postoperative complications directly related to the conversion with scarification of 2 pouches. In a mean follow-up time of 7.5 ± 6.6 years, 5/24 patients required revisional surgery. Of these, 3 required pouch excision. The cumulative probability of reoperation at the end of the second year increased to 21.7% and remained constant thereafter until the maximum follow-up time of 26 years. The total pouch loss rate was 19.2% (5/26) of which all occurred in the first 3 years. No statistically significant differences were found between the conversion types, complications or pouch survival. For all parameters, IBD patients performed slightly unfavourably. Due to the overall small number of respective patients, a differentiated investigation of IBD was not performed.
CONCLUSION: Complex conversion procedures (types 1 and 2) deliver comparable long-term results to new constructions (type 3), thereby limiting the loss of small bowel. IBD compromises outcome versus non-IBD.
PMID:35073447 | DOI:10.1111/codi.16064
