title: Transabdominal Redo Ileal Pouch Surgery for Failed Restorative Proctocolectomy: Lessons Learned Over 500 Patients.
abstract: OBJECTIVE
  The purpose of this study was to report our large, single-center experience of transabdominal ileal pouch-anal anastomoses (IPAA) redo surgery for a failed initial IPAA.
  
  
  BACKGROUND
  IPAA fail from 3% to 15% of the times, mainly due to technical or inflammatory conditions. There is limited information about the surgical, functional, and quality-of-life (QOL) outcomes of redo surgery for failed IPAA, especially in large series of patients.
  
  
  METHODS
  Patients undergoing transabdominal redo surgery for failed IPAA between 1983 and 2014 were evaluated. Primary endpoints were morbidity of the surgery, the proportion of patients with a functioning pouch, frequency of defecation and incidence of incontinence, and the patients' perception of QOL.
  
  
  RESULTS
  There were 502 (43% males) patients with a median age of 38 years and median body mass index 24 kg/m at the time of revision surgery. A new pouch was created in 41% of patients whereas 59% had their original pouch revised and retained. Postoperative mortality was 0% and morbidity was 53%. The short-term anastomotic leak rate was 8%. At a median follow-up of 7 years after redo surgery, 101 (n = 20%) patients had redo IPAA failure. Pelvic sepsis developing after redo ileal pouch surgery was the primary indicator of pouch failure (hazard ratio, 3.691; 95% confidence interval, 2.411-5.699; P < 0.0001). Overall functional outcomes and QOL scores were acceptable.
  
  
  CONCLUSIONS
  Patients with a failed ileoanal pouch may be offered redo pouch surgery with a high likelihood of success in terms of function and QOL.
authors.affiliation: *Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH †Acibadem University School of Medicine, Istanbul, Turkey ‡Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
authors.forename: Erman
authors.initials: E
authors.lastname: Aytac
authors.forename: Jean
authors.initials: J
authors.lastname: Ashburn
authors.forename: Jinyu
authors.initials: J
authors.lastname: Gu
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Hull
authors.forename: David W
authors.initials: DW
authors.lastname: Dietz
authors.forename: Luca
authors.initials: L
authors.lastname: Stocchi
authors.forename: James M
authors.initials: JM
authors.lastname: Church
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D039021:Colonic Pouches; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative / Q000379:methods*; D011788:Quality of Life; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D055815:Young Adult