Patients would readily opt for a redo pouch procedure as it allows a majority of patients to maintain intestinal continuity with good quality of life, the authors of a retrospective study pointed out during their poster presentation at the Crohn’s and Colitis Congress 2023, on January 19, in Denver, Colorado.

The study was undertaken by the gastroenterologists in the colon, rectal surgery and gastroenterology departments of Cleveland Clinic in Cleveland, Ohio. “A redo pouch procedure can be offered to maintain intestinal continuity after pouch failure, but little is known on quality of life after redo pouch,” the authors explained. “We aimed to describe long-term quality of life and functional outcomes after redo pouch.”

The researchers identified 375 patients who had completed at least one Cleveland Global Quality of Life (CGQL) questionnaire after redo pouch. The median age at redo pouch was 40 years, and 212 (57%) of the patients were women. A majority of the pouch patients were diagnosed with ulcerative colitis (UC) (87%); others were diagnosed with familial adenomatous polyposis (6%), Crohn disease (4%), and indeterminate colitis (3%).

“The median interval between index and redo pouch was 4 (2 – 6) years. The indication for redo pouch was sepsis in 230 (61%) cases, mechanical in 114 (31%), functional in 19 (5%), and dysplasia or cancer in 11 (3%),” the authors said. “The anastomosis was handsewn in 72% cases.”

After redo pouch, 95% of the patients had their stoma closed. Only 18 patients, which accounted for 5% of the total , did not have their stoma closed either because of complications or personal preference.

The researchers found that the overall CGQL score was above average. The overall CGQL score was 0.7, median quality of life score was 7, quality of health was 7, and quality of energy was 6.5. An interesting finding was that there were no differences in CGQL scores in patients who had a redo pouch due to septic complications versus other indications.

The median number of bowel movements was 6 during the daytime and 2 during the nighttime, for 8 bowel movements in a 24-hour period. Only half of the study population reported dietary restrictions, less than half (34%) reported social restrictions, 38% reported work restrictions, and 37% reported sexual restrictions. While 76% of the patients reported consistency of stool as liquid, only 24% of the patients complained of urgency occurring daily or most days, and only 10% of the patients complained of incontinence. Seepage during the day was experience by 52% of patients, nocturnally in 68%, with 53% of patients reporting daytime pad use, and 61% at night.

A large number of patients were happy with the surgery (median of 8). More than 80% of the patients would undergo surgery again, and 84% patients would recommend it to other people.

All in all, a redo pouch procedure “allows a majority of patients to maintain intestinal continuity with good quality of life,” the authors insisted. However, patients should be counseled on balancing their expectations in regard to stool frequency and consistency, urgency, incontinence, seepage, and overall success rates, they said.

—Priyam Vora

Reference:
Maspero M, Lavryk O, Holubar S, Lipman J, Qazi T, Cohen B, Steele S and Hull T. Presentation number: 15. Defining long-term quality of life and functional outcomes after redo ileal pouch anal anastomosis: What should patients and providers expect? Presented at: Crohn’s and Colitis Congress 2023; January 19, 2023. Denver, Colorado.