Association of Surgeon
Disconnection, pouch revision and reconnection of the ileal pouch-anal anastomosis
Article first published online: 7 DEC 2005
Copyright © 1996 British Journal of Surgery Society Ltd.
British Journal of Surgery
Volume 83, Issue 10, pages 1401–1405, October 1996
How to Cite
Sagar, P. M., Dozois, R. R., Wolff, B. G. and Kelly, K. A. (1996), Disconnection, pouch revision and reconnection of the ileal pouch-anal anastomosis. Br J Surg, 83: 1401–1405. doi: 10.1002/bjs.1800831025
- Issue published online: 7 DEC 2005
- Article first published online: 7 DEC 2005
- Manuscript Received: 8 JUL 1996
The aim of this retrospective study was to determine the outcome of patients with a dysfunctional pelvic ileal reservoir in whom disconnection of an ileal pouch-anal anastomosis (IPAA), pouch revision and reanastomosis had been carried out. There were 23 patients (15 women). At the revision operation functional problems were found to be due to a long efferent spout (nine patients), sepsis and/or fistula (four), a redundant blind limb (three), a twisted pouch (three), anastomotic problems (three) or no reservoir (one). The pouch was salvaged in 16 patients and a new pouch was constructed in seven. The pouch-anal anastomosis was resutured in 22 patients and stapled in one. Postoperative complications (all minor) occurred in six patients. Two patients underwent two revisions of IPAA. At a median follow-up of 5 (range 1–10) years, 11 patients reported good to excellent function, five reported fair function and one reported recurrent pouchitis. Revision surgery was unsuccessful in six of 23 patients (three had gross incontinence, two excessive bowel movements and one Crohn's disease), and they subsequently underwent pouch excision. It is concluded that revision of an ileal reservoir and IPAA can be undertaken safely with good results in carefully selected patients.