025 Permanent ostomy after ileoanal pouch failure: pouch in situ or pouch excision? (2011 Colorectal Tripartite Meeting held in conjunction with the Australian Association of Stomal Therapy Nurses Conference 3-7 July 2011 Cairns, Australia)

Aim: The risks/benefits of pouch excision versus permanent diversion (pouch left in situ) when restoration of intestinal continuity is not pursued for patients who develop pouch failure after ileoanal pouch anastomosis (IPAA) have not been well characterized. The aim of this study is to compare early and long term outcomes after the two procedures. Methods: Data pertaining to patient demographics, details of primary IPAA, reasons for pouch failure and perioperative outcomes were obtained for patients who developed pouch failure and underwent a permanent ileostomy with either the pouch left in-situ (LI) or pouch excision (PE). Patients were contacted to obtain data on quality of life (QOL) using pouch and SF-36 questionnaires. Data were then compared between the two groups. Results: One hundred and thirty-six patients with pouch failure underwent either LI (n = 31) or PE (n = 105). The two groups had similar age (P = 0.72), gender (P = 0.75), ASA score (P = 0.22), BMI (P = 0.8), disease duration (P = 0.74), time from IPAA to surgery to pouch failure (P = 0.053), diagnosis at pouch failure (P = 0.18), and follow-up (P = 0.76). Predominant cause of pouch failure was septic complications in 15 (48%) in LI and 39 (33%) in PE (P = 0.3). Three patients in LI (9.7%) had end ileostomy. Estimated blood loss at surgery was higher in PE (P < 0.001). Thirty-day complications including prolonged ileus (P = 0.59), pelvic abscess (P = 1), wound infection (P = 1), bowel obstruction (P = 1) were similar. At most recent follow-up (median, 9.9 years) quality of life (P = 0.005), quality of health (P = 0.008), current energy level (P = 0.026), Cleveland Global QOL score (P = 0.005), SF-36 mental (P = 0.004) and physical (P = 0.014) component scales were significantly higher in patients with PE than those with LI. Anal pain (n = 4), seepage with pad use (n = 8) were predominant complaints of LI group on long-term follow-up. Conclusions: Although technically more challenging, pouch excision, rather than permanent diversion, is the preferable option for patients who develop pouch failure and are not candidates for restoration of intestinal continuity. In addition to obviating the risk of cancer, pouch excision confers better long-term QOL and symptom control than permanent diversion.