REDIVERSION AFTER ILEAL POUCH ANAL ANASTOMOSIS - CAUSES OF FAILURES AND PREDICTORS OF SUBSEQUENT POUCH SALVAGE

PURPOSE: The aim of this study was to understand better the cause and predictability of pouch failure requiring rediversion after ileal pouc h-anal anastomosis and to assess the ultimate outcome of patients in a large ileal pouch series who required rediversion. METHODS: Data from 460 patients completing ileal pouch-anal anastomosis at one instituti on were recorded from both a prospectively accumulated ileal pouch reg istry and patient medical records. RESULTS: Of 460 patients, 21 (4.6 p ercent) who underwent ileal pouch-anal anastomosis required rediversio n. Five of these patients subsequently had successful restoration of p ouch continuity, leaving a permanent failure rate of 16 of 460 patient s (3.5 percent). The most common reasons for rediversion were pouch fi stula formation (12) and poor functional results (5). Preoperative fac tors, including age, previous colectomy, and indication for colectomy, did not predict eventual need for rediversion. Patients requiring red iversion had significantly higher rates of postoperative complications (95 vs. 43 percent; P < 0.001). Specifically, this group had a higher rate of postoperative pouch fistula (57 vs, 3.4 percent; P < 0.001). Additionally, a final diagnosis of Crohn's disease significantly predi cted the need for rediversion. Permanent pouch failure occurred in 36. 8 percent of patients with a final diagnosis of Crohn's disease compar ed with 1.4 percent of patients with a final diagnosis of ulcerative c olitis (P < 0.001). All five salvaged patients had fistula formation i n the absence of Crohn's disease. CONCLUSIONS: The overall rate of per manent pouch failure is low. The majority of failures were related to fistula formation associated with Crohn's disease or poor functional r esults. Pouches complicated by fistulas not associated with Crohn's di sease can be salvaged with temporary rediversion.