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Conversion of ileo‐pouch anal anastomosis to continent ileostomy: strategic surgical considerations and outcome
Author(s) -
Ecker KarlWilhelm,
Dinh Christian,
Ecker Nils K. J.,
Möslein Gabriela
Publication year - 2022
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.16064
Subject(s) - medicine , pouch , proctocolectomy , anastomosis , surgery , ileostomy , ulcerative colitis , inflammatory bowel disease , crohn's disease , retrospective cohort study , disease
Abstract Aim The aim was 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 was that complex conversions are equivalent to the primary construction of a CI at the time of proctocolectomy. Method This was a 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), type 2 (partial PR), and type 3 (complete PR). Results Twenty‐six 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 two pouches. In a mean follow‐up time of 7.5 ± 6.6 years, 5/24 patients required revisional surgery. Of these, three 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.