Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue/A30, Cleveland, OH, 44195, USA.
Int J Colorectal Dis. 2019 Nov;34(11):1945-1951. doi: 10.1007/s00384-019-03411-1. Epub 2019 Oct 30.
Crohn's disease (CD) patients after ileal anal pouch anastomosis (IPAA) are subject to CD recurrence, septic complications, and pouch failure. The aim of this study was to compare long-term outcomes of index and redo IPAA for CD.
Patients who underwent index and redo IPAA with a diagnosis of CD colitis were identified from a prospectively maintained IPAA database. Charts were reviewed to determine complications and pouch failure rates after index and redo IPAA. Long-term pouch survival and quality of life (QoL) were compared between index and redo IPAAs.
There were 305 patients, 253 with an index IPAA and 52 having a redo IPAA. Their median ages were 33 years (index IPAA) and 32 years (redo IPAA) (p = 0.91); there were 47% and 53% men in each group, respectively (p = 0.54). Pouch salvage with redo IPAA was possible in 75% of redo pouches. Biologic agents were given in 8% of index IPAA and 34% redo IPAA patients (p < 0.01). Cumulative Kaplan Meier 5-year pouch survival was 80% vs. 60% in index and redo IPAA (p < 0.0001), at 10 years 74% vs. 38%, respectively (p < 0.0001). When queried, 78% who underwent redo pouch surgery would have it again and 86% would recommend this surgery to others.
IPAA can be offered to selected patients with isolated colonic CD. Failure in this group of patients is related mainly to recurrent CD, not surgical complications. Redo IPAA is a realistic option for salvage in certain patients with failed index IPAA.
回肠贮袋肛管吻合术（IPAA）后克罗恩病（CD）患者易发生 CD 复发、感染性并发症和贮袋失败。本研究旨在比较 CD 患者初次和再次 IPAA 的长期结局。
从前瞻性维护的 IPAA 数据库中确定接受初次和再次 IPAA 治疗并诊断为 CD 结肠炎的患者。对图表进行回顾，以确定初次和再次 IPAA 后的并发症和贮袋失败率。比较初次和再次 IPAA 的贮袋长期存活率和生活质量（QoL）。
共有 305 例患者，其中 253 例接受初次 IPAA，52 例接受再次 IPAA。初次 IPAA 组和再次 IPAA 组的中位年龄分别为 33 岁和 32 岁（p = 0.91）；每组分别有 47%和 53%的男性（p = 0.54）。75%的再次贮袋可进行贮袋挽救性手术。初次 IPAA 组中有 8%的患者和再次 IPAA 组中有 34%的患者使用生物制剂（p < 0.01）。累积 Kaplan-Meier 5 年贮袋存活率分别为初次 IPAA 组 80%和再次 IPAA 组 60%（p < 0.0001），10 年时分别为 74%和 38%（p < 0.0001）。接受再次贮袋手术的患者中有 78%会再次接受手术，86%会向他人推荐该手术。
对于孤立性结肠 CD 患者，可以选择行 IPAA。该组患者的失败主要与 CD 复发有关，而与手术并发症无关。对于某些初次 IPAA 失败的患者，再次 IPAA 是一种可行的挽救选择。
