Management of Leak From the Tip of the “J” in Ileal Pouch-Anal Anastomosis

Abstract

Diagnosis and management of leak from the tip of the J-pouch after IPAA has not been systematically studied. The aim of this study is to report our experience in the diagnosis and management of these leaks following primary IPAA. This study is a retrospective review of prospectively gathered data. Data were obtained from a prospectively maintained single-institution pelvic pouch database. Included in this study were patients with a leak from the tip of the J-pouch after primary IPAA. The main measures of outcomes after salvage surgery were pouch failure, pouch function, and quality of life. There were 27 (14 male) patients. Median age was 37 years (range, 20-73). Underlying disease in these patients was ulcerative colitis in 22 patients. Predominant symptoms were abdominal pain (n = 15) and fever (n = 5). Twenty patients had either a pelvic abscess detected by CT or MRI or a leak demonstrated at gastrografin enema or pouchoscopy. In 6 patients, the diagnosis was only made at salvage surgery. In 1 patient, the leak-associated abscess was detected during emergent laparotomy for acute peritonitis before salvage surgery. Of 27 patients, 1 had successful CT-guided drainage without the need for further surgery. Another patient had pouch resection with end ileostomy. Salvage surgery was performed in 25 patients by means of pouch repair (n = 23) and new pouch creation (n = 2); 8 patients had a repeat anastomosis. Median time from primary IPAA to salvage surgery was 0.9 years (0.13-9.8). Twenty-four patients with salvage surgery have a functioning pouch after a mean follow-up of 3.2 ± 1.9 years. : The study was limited by its retrospective nature. Leak from the tip of the J-pouch is indolent and diagnosis can be difficult. Satisfactory outcomes in terms of pouch retention may be expected after appropriate surgical management.