Causes and outcomes of pouch excision after restorative proctocolectomy

Background: Pouch failure occurs in up to 10 per cent of patients after ileal pouch–anal anastomosis (IPAA). The aims of this study were to determine the reasons for pouch excision and to evaluate the outcome of the perineal wound after pouch excision. Methods: Between 1984 and 2002, 91 patients wit...

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Bibliographic Details
Published in:British journal of surgery 2006-01, Vol.93 (1), p.82-86
Main Authors: Prudhomme, M., Dehni, N., Dozois, R. R., Tiret, E., Parc, R.
Format: Article
Language:English
Subjects:
Adenomatous Polyposis Coli - surgery
Adolescent
Adult
Aged
Biological and medical sciences
Child
Colitis, Ulcerative - surgery
Colonic Neoplasms - surgery
Colonic Pouches
Crohn Disease - surgery
General aspects
Graft Rejection - etiology
Humans
Medical sciences
Middle Aged
Proctocolectomy, Restorative - methods
Recurrence
Stomach, duodenum, intestine, rectum, anus
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Treatment Outcome
Wound Healing
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Summary:Background: Pouch failure occurs in up to 10 per cent of patients after ileal pouch–anal anastomosis (IPAA). The aims of this study were to determine the reasons for pouch excision and to evaluate the outcome of the perineal wound after pouch excision. Methods: Between 1984 and 2002, 91 patients with severe ileal pouch dysfunction were treated. This was a retrospective analysis of data collected prospectively from 24 patients who underwent pouch excision. Results: Patients were grouped according to the final histological diagnosis. Fourteen patients with Crohn's disease developed extensive fistulous disease and/or recurrent abscesses, of whom six had a persistent perineal sinus after pouch excision. Five patients had familial adenomatous polyposis, in three of whom desmoid tumours were the cause of failure. Three patients had chronic ulcerative colitis and developed recurrent pelvic sepsis. Finally, two patients with multiple colorectal adenocarcinoma developed recurrent cancer (one) or sepsis (one). Conclusion: Sepsis was the principal reason for pouch excision and was usually associated with recrudescent Crohn's disease in the pouch. Perineal wound healing was problematic after pouch excision for Crohn's disease. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Crohn's disease with sepsis was the principal cause of pouch failure
ISSN:0007-1323
1365-2168
DOI:10.1002/bjs.5147