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Long-term Outcomes of Straight Ileoanal Anastomoses Converted to Ileal Pouch Anal Anastomoses
Marianna Maspero1, Olga Lavryk1, Jeremy Lipman1
1Department of Colon & Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Insights
Conversion from straight ileoanal anastomosis (SIAA) to ileal pouch anal anastomosis (IPAA) offers acceptable long-term functional outcomes and good quality of life for patients experiencing SIAA complications. This procedure can be safely recommended when SIAA fails.
Area of Science:
- Colorectal Surgery
- Pediatric Surgery
- Gastroenterology
Background:
- Ileal pouch anal anastomosis (IPAA) is standard after proctocolectomy, but straight ileoanal anastomoses (SIAA) are selectively used, particularly in pediatric cases.
- Data on outcomes following conversion from SIAA to IPAA after SIAA failure are limited.
Purpose of the Study:
- To evaluate the long-term functional outcomes of converting straight ileoanal anastomoses (SIAA) to ileal pouch anal anastomoses (IPAA).
Main Methods:
- Retrospective analysis of a prospectively collected database of pelvic pouches.
- Inclusion of patients who underwent conversion from SIAA to IPAA.
- Assessment of long-term functional outcomes and quality of life.
Main Results:
- Twenty-three patients (14 female, median age at conversion 19 years) were analyzed.
- Indications for conversion included incontinence (52%), sepsis (35%), and stricture (9%).
- Overall pouch survival was 71% at 5 years, with a median quality of life score of 8/10 and satisfaction of 9.5/10.
Conclusions:
- Conversion of SIAA to IPAA yields acceptable long-term results and enhances patient quality of life.
- This surgical option is safe and effective for patients with complications arising from SIAA.
Background:
While ileal pouch anal anastomosis (IPAA) is the recommended way to restore intestinal continuity after total proctocolectomy, straight ileoanal anastomoses (SIAA) are still selectively performed, especially in the pediatric population. In case of SIAA failure, conversion to IPAA is possible, but reports on its outcomes are scarce.
Methods:
We retrospectively analyzed our prospectively collected database on pelvic pouches, and identified patients with a SIAA that was converted to IPAA. Our aim was long-term functional outcomes.
Results:
Twenty-three patients were included (14 females, median age at SIAA 15 years, median age at conversion to IPAA 19 years). The indication for SIAA was ulcerative colitis in 17 (74%) cases, indeterminate colitis in 2 (9%) cases, and familial adenomatous polyposis in 4 (17%) cases. The indication for IPAA conversion was incontinence/poor quality of life in 12 (52%) cases, sepsis in 8 (35%) cases, anastomotic stricture in 2 (9%) cases, and prolapse in one (4%) case. The majority were diverted at IPAA conversion (22, 96%). Three (13%) patients never had stoma closure, due to patient wishes, failed healing of vaginal fistula, and pelvic sepsis, respectively. After a median follow up of 109 months (28-170), pouch failure occurred in 5 additional patients. Overall pouch survival was 71% at 5 years. Median quality of life was 8/10, of health 8/10, and of energy 7/10. Median satisfaction with surgery was 9.5/10.
Conclusion:
Conversion of SIAA to IPAA leads to acceptable long-term outcomes and good quality of life, and can safely be offered to patients with problems related to SIAA.
Level Of Evidence:
IV.
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