Third Time's the Charm? Indications and Outcomes for Redo-Redo IPAA

Area of Science:

• Surgical Gastroenterology
• Inflammatory Bowel Disease Management
• Pelvic Reconstructive Surgery

Background:

• Redo ileal pouch-anal anastomosis (IPAA) procedures have a significant failure rate, with up to 40% of cases resulting in pouch failure.
• The decision to offer a second redo IPAA to maintain intestinal continuity is controversial due to uncertain outcomes.

Purpose of the Study:

• To evaluate the institutional experience and outcomes of second redo IPAA procedures.
• To compare patient-reported outcomes and pouch survival between first and second redo IPAA procedures.

Main Methods:

• Retrospective review of patients undergoing second redo IPAA between 2004 and 2021 at a tertiary referral center.
• Propensity score matching was used to compare outcomes between patients undergoing first and second redo procedures.
• Pouch survival and patient-reported outcomes (Cleveland Global Quality of Life survey) were the primary endpoints.

Main Results:

• Twenty-three patients underwent second redo IPAA; 35% were ultimately diagnosed with Crohn's disease.
• Pouch failure occurred in 30% of cases, predominantly due to septic complications, with 3-year pouch survival at 76%.
• Quality of life and functional outcomes were comparable between first and second redo procedures, with higher incontinence rates in the second redo group.

Conclusions:

• Second redo IPAA procedures can be offered to carefully selected, highly motivated patients with acceptable outcomes.
• Septic complications are a major driver of pouch failure in second redo IPAA.
• While overall outcomes are comparable, increased incontinence should be considered in the decision-making process for second redo IPAA.