Secondary reconstruction of an ileal reservoir in patients with failed straight ileoanal pull-through: report of two cases.
The ileoanal reservoir is a widely accepted option for the treatment of mucosal ulcerative colitis and familial adenomatous polyposis. Function of an ileoanal anastomosis without the reservoir may be unacceptable. The aim of this study was to assess the technical feasibility of conversion of a straight ileoanal anastomosis to an ileoanal reservoir anastomosis. Two patients underwent straight ileoanal anastomosis and then underwent subsequent conversion to an ileoanal reservoir anastomosis. A 16-year-old girl with mucosal ulcerative colitis and a 38-year-old woman with familial adenomatous polyposis presented with 20-25 bowel movements per day and severe diarrheal-related symptoms within 11 months of ileoanal anastomosis. In each case, the anastomosis was reversed and an ileal Jpouch was fashioned and anastomosed to the dentate line; there was no postoperative morbidity. The 38-year-old patient reported 4-5 bowel movements per day without the need for any medication at 1-8 months after ileostomy closure. The 16-year-old patient is waiting ileostomy closure. In conclusion, it is technically possible to convert a straight ileoanal anastomosis to an ileoanal reservoir anastomosis with expectations of improvement in function.
Choi
J S
JS
Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331, USA.
Wexner
S D
SD
D011125:Adenomatous Polyposis Coli / Q000503:physiopathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D003093:Colitis, Ulcerative / Q000503:physiopathology / Q000601:surgery*; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D020127:Recovery of Function / Q000502:physiology; D012086:Reoperation; D017211:Treatment Failure