Primary K-pouch creation versus J-to-K pouch conversion: An IDEAL stage 3 report

Conversion of a failed ileoanal J-pouch to a continent ileostomy (K-pouch) is an uncommon salvage option that may preserve continence and small-bowel length. Outcomes after J-to-K pouch conversion compared with primary K-pouch creation remain poorly defined. This IDEAL stage 3 study compared short- and long-term outcomes between these two approaches.

We performed a retrospective review of patients undergoing primary K-pouch creation or J-to-K pouch conversion at a tertiary referral centre between 2013 and 2025. Demographic, clinical and operative characteristics, 30-day postoperative outcomes and long-term pouch-related outcomes were evaluated. Primary outcomes were pouch revision and pouch excision. Secondary outcomes included 30-day morbidity and other long-term complications.

Forty-four patients were included, of whom 28 underwent primary K-pouch creation and 16 underwent J-to-K pouch conversion. Median age, body mass index, operation duration and blood loss were comparable between groups. Thirty-day outcomes, including readmission, reoperation, ileus, abscess and transfusion, did not differ significantly. After a median follow-up of 43 vs. 42 months, pouch survival remained high in both groups (82.1% vs. 93.8%, p = 0.39). Kaplan-Meier analysis demonstrated similar revision-free (p = 0.39) and excision-free (p = 0.36) survival. On multivariable analysis, 30-day transfusion was the only independent predictor of pouch failure (odds ratio [OR] 7.56, 95% confidence interval [CI] 1.02-56.25; p = 0.048).

J-to-K pouch conversion achieved high pouch survival and 30-day morbidity comparable to primary K-pouch creation, supporting its role as an effective salvage option in selected patients with J-pouch failure.