Management of leak from the tip of the "J" in ileal pouch-anal XXXX .

@entity1 @entity254 @entity31 @entity490 @entity221 @entity298
BACKGROUND: Diagnosis and management of leak from the tip of the J-pouch after IPAA has not been systematically studied. OBJECTIVE: The aim of this study is to report our experience in the diagnosis and management of these leaks following primary IPAA. DESIGN: This study is a retrospective review of prospectively gathered data. SETTINGS: Data were obtained from a prospectively maintained single-institution pelvic pouch database. @entity1 : Included in this study were @entity1 with a leak from the tip of the J-pouch after primary IPAA. MAIN OUTCOME MEASURES: The main measures of outcomes after salvage surgery were pouch failure, pouch function, and quality of life. RESULTS: There were 27 (14 male) @entity1 . Median age was 37 years (range, 20-73). Underlying disease in these @entity1 was @entity31 in 22 @entity1 . Predominant symptoms were @entity490 (n = 15) and @entity221 (n = 5). Twenty @entity1 had either a pelvic abscess detected by CT or MRI or a leak demonstrated at gastrografin enema or pouchoscopy. In 6 @entity1 , the diagnosis was only made at salvage surgery. In 1 @entity1 , the leak-associated abscess was detected during emergent laparotomy for @entity298 before salvage surgery. Of 27 @entity1 , 1 had successful CT-guided drainage without the need for further surgery. Another @entity1 had pouch resection with end ileostomy. Salvage surgery was performed in 25 @entity1 by means of pouch repair (n = 23) and new pouch creation (n = 2); 8 @entity1 had a repeat @entity254 . Median time from primary IPAA to salvage surgery was 0.9 years (0.13-9.8). Twenty-four @entity1 with salvage surgery have a functioning pouch after a mean follow-up of 3.2    1.9 years. LIMITATIONS: : The study was limited by its retrospective nature. CONCLUSIONS: Leak from the tip of the J-pouch is indolent and diagnosis can be difficult. Satisfactory outcomes in terms of pouch retention may be expected after appropriate surgical management.
