Reoperative abdominal and perineal surgery in ileoanal pouch patients

PURPOSE: Complications of the ileal pouch with ileoanal anastomosis are ass ociated with poor function and diminished quality of life; often, these com plications may require surgery to salvage the pouch. The aims of this study were to review our experience with reoperative ileoanal pouch surgery and to define any predictors of pouch salvage surgery. METHODS: Between 1991 an d 1999, the medical records of all patients who underwent reoperative ileoa nal pouch surgery for either pouch salvage or pouch excision were reviewed; any minor local procedures were excluded. Successful ileoanal pouch salvag e was considered to be an intact and functioning pouch, with acceptable pat ient satisfaction and good control. RESULTS: Thirty-two patients underwent reoperative ileoanal pouch surgery, 25 for attempted pouch salvage and 10 f or pouch excision (3 patients were included in both groups). Five patients (20 percent) had pouch reconstruction, I of which was successful; 8 (32 per cent) had pouch advancement, with a 62 percent success rate; and 16 (64 per cent) had local perianal procedures for control of perianal sepsis, with a 75 percent success rate (4 of these required further surgery). The overall success rate of ileoanal pouch salvage surgery was 84 percent, with 64 perc ent of patients having acceptable function. There was no correlation betwee n the number of ileoanal pouch salvage procedures and failure. Four (40 per cent) of the 10 patients who had pouch excision were ultimately diagnosed w ith Crohn's disease. CONCLUSIONS: Ileoanal pouch salvage surgery is often s uccessful and, in motivated patients without Crohn's disease, is worthwhile . Pouch advancement or local perianal repair yielded better results than di d pouch reconstruction. Patients diagnosed with Crohn's disease after ileoa nal pouch construction may be best suited for pouch excision when complicat ions occur.