Conversion of ileo-pouch anal anastomosis to continent ileostomy: strategic surgical considerations and outcome.

Abstract

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. 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). 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±6.6years, 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 26years. The total pouch loss rate was 19.2% (5/26), of which all occurred in the first 3years. 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. 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.