Pouch Salvage Surgery for Treatment of Colitis and Familial Adenomatous Polyposis: Report of Five Cases

Abstract

Introduction: The restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is currently the preferred surgicalmethod for most patients with ulcerative colitis and familial adenomatous polyposis and sometimes, functional bowel diseases.Infection around the pouch, remaining rectal stump, stricture at anastomosis site, pouch dysfunction and refractory pouchitis canlead to pouch failure. Pouch salvage surgery could prevent pouch failure in some cases.Case Presentation: In this report, five patients were introduced, who underwent pouch salvage surgery after RPC/IPAA surgeryfailure. Two of the patients were male and three were female and the relevant age range was 16 to 41. Initially, RPC/IPAA surgerywas performed on these five patients. Four of the patients underwent RPC/IPAA surgery as a result of ulcerative colitis and, one ofthe patients as a result of familial adenomatous polyposis. However, due to pouch failure from the RPC/IPAA surgery, pouch-salvagesurgery was performed on each of these five patients. Two of the patients underwent pouch-salvage surgery due to infection andpouch fistula, and the other three underwent this surgery due to the remaining rectal stump, anastomosis stenosis and pouchdysfunction. The average time for when pouch-salvage surgery was performed was 3.5 years (three months to five years) after theinitial operation and the patients were under follow-up care for two to seven years.Conclusions: After performing pouch salvage operation, pouch function was acceptable in all patients and we could closeileostomies of all of them.

Keywords

• familial adenomatous polyposis
• ilioanal pouch
• sepsis
• total proctocolectomy
• ulcerative colitis