Ileal pouch salvage following failed ileal pouch-anal anastomosis

Attempts have been made to salvage failed ileal pouch-anal anastomoses (IPA A) performed for ulcerative colitis or familial polyposis coli. These can b e categorized as total reconstruction of the IPAA, partial transabdominal a pproach, and partial transperineal approach. The aims of our study were to determine the overall success of pouch salvage; to examine the demographics , indications, and outcomes for each approach; and to assess anorectal phys iology and patient satisfaction in those with successful salvage operations . We reviewed data, including results of anorectal manometry from 29 patien ts undergoing salvage procedures for failed IPA. Seventeen salvage attempts were successful, 11 attempts failed, and one patient was lost to follow-up . Success rates were 100% in the total reconstruction group, 25% in the par tial transabdominal group, and 55% in the transperineal group. In those un dergoing total reconstruction of the IPAA (n = 9), functional outcome, as m easured by incontinence, improved with 50% reporting incontinence preoperat ively compared to 0% postoperatively (P = 0.055). Mean 24-hour stool freque ncy and nighttime stool frequency declined. All patients reported satisfact ion with their outcomes. Sixty percent of patients who underwent ileal pouc h salvage following IPAA have been successful in avoiding permanent ileosto my. These results suggest that a continued effort to salvage failed IPAA, i ncluding the use of total reconstruction, is a viable alternative to perman ent ileostomy.