Durability of ileal pouch-anal anastomosis and continent ileostomy.
OBJECTIVE
This study was designed to evaluate pouch durability and salvage in patients undergoing continent ileostomy and ileal pouch-anal anastomosis.


METHODS
Three hundred seventeen patients undergoing ileal pouch-anal anastomosis and 63 undergoing continent ileostomy were evaluated in a prospective observational study. Median observation time was 10.6 (range, 1-23) years for patients who underwent ileal pouch-anal anastomosis and 14 (1-24) years for those who underwent continent ileostomy.


RESULTS
Twenty-three pelvic pouches failed (8%), and six continent ileostomies (10%) were excised (difference not significant). Estimated failure rates at 20 years were 11.4% (CI, +/-4.8) for ileal pouch-anal anastomosis and 11.6% (CI, +/-8,2) for continent ileostomy (P = 0.8). Sixty-five patients who had received an ileal pouch-anal anastomosis (21%) and 21 of those who had a continent ileostomy (30%) had one or more salvage procedures. Estimated salvage rates at 20 years were 31% vs. 38%, respectively (P = 0.06). The crude success rates of functioning ileal pouch-anal anastomosis and continent ileostomy were 92.8% and 90.5%, respectively.


CONCLUSIONS
Success rates after ileal pouch-anal anastomosis and continent ileostomy are high. Their rates of failure are similar. Salvage procedures are substantial with both procedures. Complications and failure after continent ileostomy are not inferior to those after ileal pouch-anal anastomosis. Continent ileostomy remains an option in patients for whom ileal pouch-anal anastomosis is unsuitable.
Wasmuth
Hans H
HH
Department of Gastrointestinal Surgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. Hans.Wasmuth@stolav.no;hawas@online.no
Myrvold
Helge E
HE
D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003082:Colectomy; D003108:Colonic Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D013536:Suture Techniques / Q000009:adverse effects; D013997:Time Factors; D017211:Treatment Failure; D055815:Young Adult