Transabdominal salvage surgery after pouch failure in a tertiary center: a case-matched study

Background: Salvage surgery after failure of ileal pouch-anal anastomosis (IPAA) could be offered to selected patients. However, the results vary widely in different centers. Aims: To assess the outcomes of salvage surgery by comparison with a control group matched for confounding variables. Methods: From a prospective database of 1286 IPAA, patients undergoing transabdominal salvage surgery were compared for perioperative and functional outcomes and quality of life (QOL) to a 1:3 control group of primary IPAA cases. Results: Salvage surgery patients (30) had a higher rate of hand-sewn anastomoses (80 vs 20%, p <. 0.0001) and reoperations (10 vs 2.2%, p 0.02) than control group (90). A higher number of daytime and nighttime bowel movements (7.4 vs 4.1, p <. 0.0001, and 2.6 vs 1.8, p = 0.002), a lower median CGQL score (0.7 vs 0.8, p = 0.0001) and a higher rate of pouch fistulae (13.3 vs 1.1%, p = 0.003) were reported after salvage surgery. Pouch failure rate after salvage surgery was 10.1%, 18.7% and 26.8% at 1, 5 and 10 years (vs 0%, 3.5% and 8.4% in control group, p = 0.0085). Conclusions: Although worse functional outcomes and decreased QOL have to be expected, salvage surgery after pouch failure is associated with acceptable outcomes when performed in a referral center.