INTRAOPERATIVE REASONS FOR ABANDONING ILEAL POUCH-ANAL ANASTOMOSIS PROCEDURES

PURPOSE: Ileal pouch-anal anastomosis (IPAA) has become the operation of choice for most patients with chronic ulcerative colitis and famili al adenomatous polyposis. However, because of technical or disease fac tors at the time of pouch construction, IPAA must sometimes be abandon ed. A retrospective review was conducted to find reasons for IPAA fail ure or abandonment. METHODS: Since 1981, 103 patients have had to have an IPAA procedure at the George Washington University Medical Center in Washington, DC. All charts were reviewed and data retrospectively c ollected. RESULTS: Six of 103 patients (six percent) were unable to ha ve IPAA constructed. Five patients ultimately received a standard end ileostomy, and one had an ileorectal anastomosis. The reasons for aban doning the IPAA procedure were an ischemic pouch, failure to reach the anus, poorly controlled presacral hemorrhage, desmoid of the mesenter y, and finding incurable colon carcinoma. CONCLUSIONS: Information reg arding the risk of failure or abandonment during the IPAA procedure sh ould be discussed with the patient during preoperative counseling and must be included as an element of informed consent.