Ileal Pouch Excision: A Contemporary Observational Cohort.

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Surgical Outcomes

Background:

• Ileal pouch failure affects approximately 10% of patients within 10 years, necessitating pouch excision when ileostomy or revision surgery is insufficient.
• A growing number of patients require pouch excision due to increasing rates of pouch failure.

Purpose of the Study:

• To describe the indications for pelvic ileal pouch excision.
• To report postoperative outcomes, including perineal wound healing, morbidity, and mortality, at a tertiary referral center.

Main Methods:

• Retrospective observational study of 92 patients undergoing pelvic ileal pouch excision between 2004 and 2017.
• Primary outcomes included time to perineal wound healing and healing at 6 months; 30- and 90-day morbidity and mortality were also evaluated.

Main Results:

• The median time from pouch creation to excision was 7 years.
• Perineal wound healing at 6 months was achieved in 78% of patients.
• Noninfective indications (OR, 15.22) and more recent procedures (OR, 12.00) were associated with significantly improved healing.

Conclusions:

• Pouch excision is a viable option for patients with refractory ileal pouch dysfunction, with a notable learning curve and improving outcomes over time.
• While postoperative morbidity remains, factors like noninfective indications and institutional volume contribute to better perineal wound healing.
• Further research is needed to assess the quality-of-life impact of pouch excision in contemporary patient cohorts.