Rediversion after ileal pouch-anal XXXX . Causes of failures and predictors of subsequent pouch salvage.

@entity1 @entity254 @entity31 @entity260 @entity292 @entity30
PURPOSE: The aim of this study was to understand better the cause and predictability of pouch failure requiring rediversion after ileal pouch-anal @entity254 and to assess the ultimate outcome of @entity1 in a large ileal pouch series who required rediversion. METHODS: Data from 460 @entity1 completing ileal pouch-anal @entity254 at one institution were recorded from both a prospectively accumulated ileal pouch registry and @entity1 medical records. RESULTS: Of 460 @entity1 , 21 (4.6 percent) who underwent ileal pouch-anal @entity254 required rediversion. Five of these @entity1 subsequently had successful restoration of pouch continuity, leaving a permanent failure rate of 16 of 460 @entity1 (3.5 percent). The most common reasons for rediversion were pouch @entity292 formation (12) and poor functional results (5). Preoperative factors, including age, previous colectomy, and indication for colectomy, did not predict eventual need for rediversion. @entity1 requiring rediversion had significantly higher rates of @entity260 (95 vs. 43 percent; P < 0.001). Specifically, this group had a higher rate of postoperative pouch @entity292 (57 vs. 3.4 percent; P < 0.001). Additionally, a final diagnosis of @entity30 significantly predicted the need for rediversion. Permanent pouch failure occurred in 36.8 percent of @entity1 with a final diagnosis of @entity30 compared with 1.4 percent of @entity1 with a final diagnosis of @entity31 (P < 0.001). All five salvaged @entity1 had @entity292 formation in the absence of @entity30 . CONCLUSIONS: The overall rate of permanent pouch failure is low. The majority of failures were related to @entity292 formation associated with @entity30 or poor functional results. Pouches complicated by fistulas not associated with @entity30 can be salvaged with temporary rediversion.
