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Clin Colon Rectal Surg 2022; 35(06): 487-494
DOI: 10.1055/s-0042-1758140
Review Article

Pelvic Pouch Failure: Treatment Options

Patricio B. Lynn
1   Division of Colorectal Surgery, New York–Presbyterian/Weill-Cornell Medical Center, New York, New York
,
Stephen Brandstetter
2   Department of Surgery, Cleveland Clinic Foundation-Akron, Cleveland, Ohio
,
David M. Schwartzberg
3   Division of Colorectal Surgery & Inflammatory Bowel Disease, Department of Surgery, New York–Presbyterian/Columbia University Medical Center, New York, New York
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Abstract

Up to 30% of patients with ulcerative colitis (UC) will require surgical management of their disease during their lifetime. An ileal pouch-anal anastomosis (IPAA) is the gold standard of care, giving patients the ability to be free from UC's bowel disease and avoid a permanent ostomy. Despite surgical advancements, a minority of patients will still experience pouch failure which can be debilitating and often require further surgical interventions. Signs and symptoms of pouch failure should be addressed with the appropriate workup and treatment plans formulated according with the patient's wishes. This article will discuss the identification, workup, and treatment options for pouch failure after IPAA.

Keywords

ulcerative colitis - total proctocolectomy - ileal pouch-anal anastomosis - redo pouch - pouch failure


Publication History

Article published online:
02 November 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Uchino M, Ikeuchi H, Sugita A. et al; a research grant on intractable disease affiliated with the Japan Ministry of Health Labor Welfare. Pouch functional outcomes after restorative proctocolectomy with ileal-pouch reconstruction in patients with ulcerative colitis: Japanese multi-center nationwide cohort study. J Gastroenterol 2018; 53 (05) 642-651
    CrossrefPubMedGoogle Scholar
  • 2 Fazio VW, Ziv Y, Church JM. et al. Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg 1995; 222 (02) 120-127
    CrossrefPubMedGoogle Scholar
  • 3 Dayton MT, Larsen KR, Christiansen DD. Similar functional results and complications after ileal pouch-anal anastomosis in patients with indeterminate vs ulcerative colitis. Arch Surg 2002; 137 (06) 690-694 , discussion 694–695
    CrossrefPubMedGoogle Scholar
  • 4 Mark-Christensen A, Erichsen R, Brandsborg S. et al. Pouch failures following ileal pouch-anal anastomosis for ulcerative colitis. Colorectal Dis 2018; 20 (01) 44-52
    CrossrefPubMedGoogle Scholar
  • 5 Carpenter H, Hotouras A, English WJ, Taylor FGM, Andreani S. Revisional ileoanal pouch surgery: a systematic literature review assessing outcomes over the last 40 years. Colorectal Dis 2021; 23 (01) 52-63
    CrossrefPubMedGoogle Scholar
  • 6 Heuthorst L, Wasmann KATGM, Reijntjes MA, Hompes R, Buskens CJ, Bemelman WA. Ileal pouch-anal anastomosis complications and pouch failure: a systematic review and meta-analysis. Annals of Surgery Open. 2021; 2 (02) e074
    CrossrefPubMedGoogle Scholar
  • 7 McCombie A, Lee Y, Vanamala R. et al. Early postoperative complications have long-term impact on quality of life after restorative proctocolectomy. Medicine (Baltimore) 2016; 95 (27) e3966
    CrossrefPubMedGoogle Scholar
  • 8 Theodoropoulos GE, Choman EN, Wexner SD. Salvage procedures after restorative proctocolectomy: a systematic review and meta-analysis. J Am Coll Surg 2015; 220 (02) 225-42.e1
    CrossrefPubMedGoogle Scholar
  • 9 Kiran RP, da Luz Moreira A, Remzi FH. et al. Factors associated with septic complications after restorative proctocolectomy. Ann Surg 2010; 251 (03) 436-440
    CrossrefPubMedGoogle Scholar
  • 10 Ritter KA, Burke JP, Stocchi L. et al. Postoperative steroid taper is associated with pelvic sepsis after ileal pouch-anal anastomosis. Inflamm Bowel Dis 2019; 25 (08) 1383-1389
    CrossrefPubMedGoogle Scholar
  • 11 Gu J, Remzi FH, Shen B, Vogel JD, Kiran RP. Operative strategy modifies risk of pouch-related outcomes in patients with ulcerative colitis on preoperative anti-tumor necrosis factor-α therapy. Dis Colon Rectum 2013; 56 (11) 1243-1252
    CrossrefPubMedGoogle Scholar
  • 12 Alsafi Z, Snell A, Segal JP. Prevalence of ‘pouch failure’ of the ileoanal pouch in ulcerative colitis: a systematic review and meta-analysis. Int J Colorectal Dis 2022; 37 (02) 357-364
    CrossrefPubMedGoogle Scholar
  • 13 Schwartzberg DM, Esen E, Remzi FH. Thoughtful ileostomy creation in patients undergoing redo IPAA. Dis Colon Rectum 2020; 63 (01) 117-120
    CrossrefPubMedGoogle Scholar
  • 14 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 (04) 454-459
    CrossrefPubMedGoogle Scholar
  • 15 Erkek AB, Remzi FH, Hammel JP, Akyuz M, Fazio VW. Effect of small bowel obstruction on functional outcome and quality of life in patients with ileal pouch-anal anastomosis: 10-year follow-up study. J Gastroenterol Hepatol 2008; 23 (01) 119-125
    CrossrefPubMedGoogle Scholar
  • 16 MacLean AR, Cohen Z, MacRae HM. et al. Risk of small bowel obstruction after the ileal pouch-anal anastomosis. Ann Surg 2002; 235 (02) 200-206
    CrossrefPubMedGoogle Scholar
  • 17 Shen B, Remzi FH, Lavery IC, Lashner BA, Fazio VW. A proposed classification of ileal pouch disorders and associated complications after restorative proctocolectomy. Clin Gastroenterol Hepatol 2008; 6 (02) 145-158 , quiz 124
    CrossrefPubMedGoogle Scholar
  • 18 Kirat HT, Kiran RP, Remzi FH, Fazio VW, Shen B. Diagnosis and management of afferent limb syndrome in patients with ileal pouch-anal anastomosis. Inflamm Bowel Dis 2011; 17 (06) 1287-1290
    CrossrefPubMedGoogle Scholar
  • 19 Read TE, Schoetz Jr DJ, Marcello PW. et al. Afferent limb obstruction complicating ileal pouch-anal anastomosis. Dis Colon Rectum 1997; 40 (05) 566-569
    CrossrefPubMedGoogle Scholar
  • 20 Holubar S, Lightner A, Qazi T. et al. Twisted pouch syndrome - a difficult to diagnose mechanical complication of ileal pouch-anal anastomosis: outcomes after redo pouch procedures. Gastroenterology 2021; 160 (03) S22-S23
    CrossrefPubMedGoogle Scholar
  • 21 Fazio VW, Kiran RP, Remzi FH. et al. Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 2013; 257 (04) 679-685
    CrossrefPubMedGoogle Scholar
  • 22 Esen E, Keshinro A, Remzi FH. Ileoanal pouch: pelvic sepsis and poor function-now what?. J Laparoendosc Adv Surg Tech A 2021; 31 (08) 867-874
    CrossrefPubMedGoogle Scholar
  • 23 Mark-Christensen A, Kjær MD, Ganesalingam S. et al. Increasing incidence of pelvic sepsis following ileal pouch-anal anastomosis for ulcerative colitis in Denmark: a nationwide cohort study. Dis Colon Rectum 2019; 62 (08) 965-971
    CrossrefPubMedGoogle Scholar
  • 24 Esen E, Kirat HT, Aytac E, Schwartzberg DM, Remzi FH. Primary pouch preservation vs new pouch creation during re-do surgery for failed ileal pouches: are the outcomes comparable?. J Am Coll Surg 2019; 229 (04) S69
    CrossrefPubMedGoogle Scholar
  • 25 Remzi FH, Aytac E, Ashburn J. et al. Transabdominal redo ileal pouch surgery for failed restorative proctocolectomy: lessons learned over 500 patients. Ann Surg 2015; 262 (04) 675-682
    CrossrefPubMedGoogle Scholar
  • 26 Kirat HT, Esen E, Schwartzberg DM, Remzi FH. The usefulness of S- and H-pouch configurations in ileal pouch salvage surgery - a video vignette. Colorectal Dis 2020; 22 (01) 112
    CrossrefPubMedGoogle Scholar
  • 27 Esen E, Erkan A, Aytac E. et al. Handsewn versus stapled IPAA in redo setting: indications, patient characteristics, operative, functional, and quality-of-life outcomes. Dis Colon Rectum 2021; 64 (08) 1014-1019
    CrossrefPubMedGoogle Scholar
  • 28 Kiran RP, Kirat HT, Rottoli M, Xhaja X, Remzi FH, Fazio VW. Permanent ostomy after ileoanal pouch failure: pouch in situ or pouch excision?. Dis Colon Rectum 2012; 55 (01) 4-9
    CrossrefPubMedGoogle Scholar
  • 29 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 (07) 880-886
    CrossrefPubMedGoogle Scholar
  • 30 Rottoli M, Vallicelli C, Gionchetti P, Rizzello F, Boschi L, Poggioli G. Transabdominal salvage surgery after pouch failure in a tertiary center: a case-matched study. Dig Liver Dis 2018; 50 (05) 446-451
    CrossrefPubMedGoogle Scholar
  • 31 Simillis C, Faiz O. Ileal pouch salvage, pouch failure and redo surgery. In: Warusavitarne J, Perry-Woodford Z. eds. The Ileoanal Pouch: A Practical Guide for Surgery, Management and Troubleshooting. Springer International Publishing; 2019: 75-89
    Google Scholar
  • 32 Lightner AL, Shogan BD, Mathis KL. et al. Revisional and reconstructive surgery for failing IPAA is associated with good function and pouch salvage in highly selected patients. Dis Colon Rectum 2018; 61 (08) 920-930
    CrossrefPubMedGoogle Scholar
  • 33 Remzi FH, Esen E, Aytac E, Kirat HT, Schwartzberg DM, Pachter HL. Complex re-do IPAA and index IPAA surgery: equivalent short-term outcomes in specialized high-volume center. J Am Coll Surg 2019; 229 (04) S56
    CrossrefPubMedGoogle Scholar
  • 34 Esen E, Lynn PB, Da Luz Moreira A. et al. Operative, long-term and quality of life outcomes after salvage of failed re-do ileal pouch anal anastomosis. Colorectal Dis 2022; 24 (06) 790-792
    CrossrefPubMedGoogle Scholar
  • 35 Pellino G, Selvaggi F. Outcomes of salvage surgery for ileal pouch complications and dysfunctions. the experience of a referral centre and review of literature. J Crohn's Colitis 2015; 9 (07) 548-557
    CrossrefPubMedGoogle Scholar