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World J Surg Proced. Mar 28, 2015; 5(1): 119-126
Published online Mar 28, 2015. doi: 10.5412/wjsp.v5.i1.119
Ileo-anal pouch excision: A review of indications and outcomes
Caroline Mary Byrne, Paul Stephen Rooney
Caroline Mary Byrne, Paul Stephen Rooney, Department of Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, L7 8XP Liverpool, United Kingdom
Author contributions: Both authors contributed to this work.
Conflict-of-interest: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Paul Stephen Rooney, Consultant General and Colorectal Surgeon, Department of Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot Street, L7 8XP Liverpool, United Kingdom. paul.rooney@rlbuht.nhs.uk
Telephone: +44-151-7063426 Fax: +44-151-7063480
Received: September 28, 2014
Peer-review started: September 28, 2014
First decision: November 14, 2014
Revised: January 12, 2015
Accepted: January 30, 2015
Article in press: February 2, 2015
Published online: March 28, 2015
Processing time: 186 Days and 15.1 Hours
Abstract

Restorative proctocolectomy (RP) is the surgical treatment of choice for ulcerative colitis (UC) and patients with familial adenomatous polyposis (FAP). A devastating complication for both patient and surgeon is failure of the pouch that requires excision. There is currently no single paper in the literature that consolidates the indications for ileo-anal pouch excision and the subsequent outcomes following this procedure. A literature search was carried out to identify articles on RP and ileal pouch-anal anastomosis. The main search terms used were “RP”; “ileal pouch-anal anastomosis” or “ileal reservoir” or “ileal pouch”; “failure of ileal pouch-anal anastomosis” and “excision of ileal pouch-anal anastomosis”. The search was completed using electronic databases MEDLINE, PubMed and EMBASE from 1975 to June 2014. Characteristics of patients with pouch failure differ between institutions. Reported overall excision rates of the pouches vary and in this review ranged from 0.93% to 12.8%. Age and lower institutional volume (less than 3.3 cases) were independent predictors of pouch failure; however surgeon case load was not. The main reasons identified for excision are sepsis (early cause), Crohn’s disease and poor functional outcomes (both late causes). Pouch cancers in UC and FAP are still rare but 135 cases exist in the literature. The most common complication following excision is persistent perineal sinus. The decision to excise a pouch should not be taken lightly and an awareness of the technical pitfalls and complications that can occur should be fully appreciated.

Keywords: Indications and outcomes; Ileo-anal pouch; Pouch failure; Pouch excision

Core tip: There is currently no single paper in the literature that consolidates the indications for ileo-anal pouch excision and the subsequent outcomes.Reported overall excision rates vary and in this review ranged from 0.93% to 12.8%. Age and lower institutional volume (< 3.3 cases) were independent predictors of pouch failure; however surgeon case load was not.Main reasons identified for excision are sepsis (early), Crohn’s disease and poor functional outcomes (both late causes). Pouch cancers in ulcerative colitis and familial adenomatous polyposis are rare but 135 cases exist in the literature. An awareness of the technical pitfalls and complications that can occur should be fully appreciated.