Interposition of a gastric pouch between ileum and anus after proctocolectomy: Long-term results in 3 patients

• Published in: Surgery Vol. 145; no. 5; pp. 568 - 572
• Main Authors: Ortega-Deballon, Pablo, MD, PhD, Cheynel, Nicolas, MD, PhD, Di-Giacomo, Giovanni, MD, Hareth, Rezkallah, MD, Facy, Olivier, MD, Rat, Patrick, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.05.2009; Elsevier
• Subjects: Adenomatous Polyposis Coli; Adenomatous Polyposis Coli - surgery; Adult; Biological and medical sciences; Colitis, Ulcerative; Colitis, Ulcerative - surgery; Colonic Pouches; Female; Follow-Up Studies; Gastroplasty; Gastroplasty - methods; General aspects; Human health and pathology; Humans; Life Sciences; Male; Medical sciences; Middle Aged; Proctocolectomy, Restorative; Proctocolectomy, Restorative - methods; Quality of Life; Stomach, duodenum, intestine, rectum, anus; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Human; Stomach; Digestive system; Patient; Small intestine; Ileum; Long term; Result; Medicine; Treatment; Anus; Surgery; Rectum; Proctocolectomy; Colon; Interposition
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2008.12.014

Background After proctocolectomy, ileal pouch-anal anastomosis may not be feasible, especially in the case of desmoid tumor or after failed ileal pouch-anal anastomosis requiring excision of the pouch. We designed a gastric pouch interposed between the terminal ileum and the anus to avoid a permanent ileostomy for these patients. Long-term results and quality of life with this technique remain unknown. Methods After proctocolectomy, ileal pouch-anal anastomosis was not feasible or had failed in 3 patients (2 with familial adenomatous polyposis and 1 with ulcerative colitis; 40, 49, and 50 years of age, respectively). Of these patients, 2 had undergone end ileostomy 7 and 8 years previously. A pouch was created using the left half of the gastric fundus, supplied through the right gastroepiploic vessels; the pouch was anastomosed proximally to the terminal ileum and distally to the anus. Diverting ileostomy was performed in all patients. Results After a mean follow-up of 6 years, all 3 patients were highly satisfied with the operation and described their quality of life as good. The median stool frequency during the day and night were 6 and 1, respectively. No patient reported incontinence or urgency. Of the 3 patients, 2 had minimal soiling with gastric juice; 1 patient had anastomotic ulcers with bleeding requiring resection with reanastomosis. All of the patients needed long-term proton pump inhibitor therapy and topical perianal treatment to prevent skin burning. Conclusion Inter-ileoanal gastroplasty is a surgical salvage technique that can avoid a permanent ileostomy. The procedure provides a good quality of life for patients with unfeasible or failed ileal pouch.