Ileoanal pouch salvage rates with endoluminal vacuum therapy for early vs late anastomotic leaks.

Background: Anastomotic leaks after ileal pouch-anal anastomosis (IPAA) significantly compromise patient outcomes and increase healthcare resource utilization. The aim of this study was to evaluate the outcomes of endoluminal vacuum therapy (EndoVac) for pouch leaks. We hypothesized that EndoVac for early compared with late leaks was associated with a higher pouch survival rate.

Transanal circumferential pouch advancement for treatment of pouch vaginal fistulae.

Background: Ileal pouch anal anastomosis (IPAA) circumferential pouch advancement (CPA) involves full-thickness transanal 180-360° dissection of the distal pouch, allowing the advancement of healthy bowel to cover the internal opening of a vaginal fistula. We aimed to describe the long-term outcomes of this rare procedure.

Methods: Patients with IPAA who underwent transanal pouch advancement for any indication between 2009 and 2021 were included.

Evaluating complete response rates and predictors in total neoadjuvant therapy for rectal cancer.

Background: There is a paradigm shift in the management of locally advanced rectal cancer (LARC) from conventional neoadjuvant treatment to total neoadjuvant therapy (TNT). Despite its growing acceptance, there are limited studies that have examined its effects on disease presentation. In addition, it is important to determine the factors that play a role in complete response (CR).

Long-term ileoanal pouch survival after pouch urinary tract fistulae.

Background: Ileoanal pouch is a demanding procedure with many potential technical complications including bladder or ureteral injury, while inflammation or stricture of the anastomosis or anal transition zone may lead to the formation of strictures and fistulae, including to the adjacent urethra. Pouch urinary tract fistulae are rare. We aimed to describe the presentation, diagnostic workup, and management of patients with pouch urinary at our center.

Three-dimensional Pouchography: A Proof-of-concept Study of a Breakthrough Technique for Visualising Ileoanal Pouch Anatomy and Morphology in Normal and Mechanical Pouch Complication Patients.

Background: Herein, we present a proof-of-concept study of three-dimensional [3D] pouchography using virtual and printed 3D models of ileal pouch-anal anastomosis [IPAA] in patients with normal pouches and in cases of mechanical pouch complications.

Methods: We performed a retrospective, descriptive case series of a convenience sample of 10 pouch patients with or without pouch dysfunction, who had CT scans appropriate for segmentation who were identified from our pouch registry. The steps involved in clinician-driven automated 3D reconstruction are presented.

Outcome of incidental versus preoperatively diagnosed colorectal cancer during total proctocolectomy with ileal pouch-anal anastomosis for inflammatory bowel disease.

Aim: Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the treatment of choice for colorectal cancer (CRC) in inflammatory bowel disease. CRC may also be discovered incidentally at IPAA for other indications. We sought to determine whether incidentally found CRC at IPAA was associated with worse outcomes.

Third Time's the Charm? Indications and Outcomes for Redo-Redo IPAA.

Background: Up to 20% to 40% cases of redo IPAA procedures will result in pouch failure. Whether to offer a second redo procedure to maintain intestinal continuity remains a controversial decision.

Objective: To report our institutional experience of second redo IPAA procedures.

Incidental Dysplasia During Total Proctocolectomy With Ileoanal Pouch: Is It Associated With Worse Outcomes?

Background: Patients with inflammatory bowel disease (IBD) are at increased risk of colorectal cancer. In cases of invisible or nonendoscopically resectable dysplasia found at colonoscopy, total proctocolectomy with ileal pouch anal anastomosis can be offered with good long-term outcomes; however, little is known regarding cancer-related outcomes when dysplasia is found incidentally after surgery on final pathology.

Methods: Using our prospectively collected pouch registry, we identified patients who had preoperative colonic dysplasia or dysplasia found only after colectomy.

Does the age of ulcerative colitis diagnosis impact outcomes of restorative proctocolectomy?

Background: Ulcerative colitis (UC) can be diagnosed at a variety of different ages. We evaluated if age of ulcerative colitis (UC) diagnosis impacts outcomes of restorative proctocolectomy (RP) with ileal pouch-anal anastomosis (IPAA).

Methods: A prospectively maintained pouch database (1983-2020) was queried to identify patients undergoing an RP for UC.

Redo ileal pouch-anal anastomosis for early versus late sepsis-related pouch failure.

Background: Pouch failure after restorative proctocolectomy with ileal pouch-anal anastomosis occurs in 5% to 15% of cases, mostly due to septic complications. We aimed to determine if the timing of pouch failure impacted long-term outcomes for redo ileal pouch-anal anastomosis after sepsis-related complications.

Method: We retrospectively analyzed our prospectively collected institutional pouch database.

Ileal Pouch-anal Anastomosis in Primary Sclerosing Cholangitis-inflammatory Bowel Disease (PSC-IBD): Long-term Pouch and Liver Transplant Outcomes.

Objective: To compare the effect of liver transplantation (LT) on ileal pouch-anal anastomosis (IPAA) outcomes in patients with primary sclerosing cholangitis and inflammatory bowel disease (PSC-IBD).

Background: Patients with PSC-IBD may require both IPAA for colitis and LT for PSC.

Methods: Patients with PSC-IBD from out institutional pouch registry (1985-2022) were divided according to LT status and timing of LT (before and after IPAA) and their outcomes analyzed.

Turnbull-Cutait Pull-Through Procedure Is an Alternative to Permanent Ostomy in Patients With Complex Pelvic Fistulas.

Background: A permanent stoma is frequently recommended in the setting of complex or recurrent rectovaginal fistulas because of the high failure rate of reconstructive procedures. The Turnbull-Cutait pull-through procedure is a salvage operation for motivated patients desiring to avoid permanent fecal diversion.

Objective: To analyze the cure rates of complex rectovaginal fistulas after the Turnbull-Cutait pull-through procedure based on cause.

Long-term Outcomes of Straight Ileoanal Anastomoses Converted to Ileal Pouch Anal Anastomoses.

Background: While ileal pouch anal anastomosis (IPAA) is the recommended way to restore intestinal continuity after total proctocolectomy, straight ileoanal anastomoses (SIAA) are still selectively performed, especially in the pediatric population. In case of SIAA failure, conversion to IPAA is possible, but reports on its outcomes are scarce.

Methods: We retrospectively analyzed our prospectively collected database on pelvic pouches, and identified patients with a SIAA that was converted to IPAA.

Redo Continent Ileostomy in Patients With IBD: Valuable Lessons Learned Over 25 Years.

Background: Patients with IBD with continent ileostomies may require revision surgeries. There remains a paucity of data regarding outcomes after redo continent ileostomy.

Objective: This study aimed to evaluate patient outcomes after redo continent ileostomy.

Management and Outcomes of Ileal Pouch-Urethral Fistulas.

Objective: To describe a single-center experience with the management of ileal pouch-urethral fistulas (IPUF) following restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA).

Methods: We retrospectively identified patients with documented IPUF managed at our institution from a urethral fistula cohort and analyzed their cases.

Results: Thirteen patients who underwent surgeries for IPUF management from 2005-2022 were identified.

Pouch volvulus-why adhesions are not always the enemy.

Aim: Minimally invasive approaches to proctocolectomy with ileal pouch anal anastomosis have become the standard of care with one benefit being the reduced risk of adhesion-related complications. However, a lack of pouch adherence to the pelvis can lead to increased mobility as well as volvulization, placing pouch viability at risk. We aimed to describe our institutional experience with pouch volvulus.

Turnbull-Cutait abdominoperineal pull-through operation: The Cleveland Clinic experience in the 21st century.

Aim: The Turnbull-Cutait pull-through procedure (TCO) restores intestinal continuity in the setting of chronic pelvic sepsis, colorectal anastomotic leak, complex pelvic fistulas and technical challenges related to complicated rectal cancer. The aim of this study was to evaluate the outcomes of the TCO for salvaging complex pelvic conditions and to compare it to hand-sewn immediate coloanal anastomosis (CAA).

Methods: This is a retrospective single-institution study where we searched a prospectively maintained database to identify patients who underwent the TCO.

Right colon, left colon, and rectal cancer have different oncologic and quality of life outcomes.

Purpose: Colorectal cancer patients are commonly considered a single entity in outcomes studies. This is particularly true for quality of life (QOL) studies. This study aims to compare oncologic and QOL outcomes between right colon, left colon, and rectal cancer in patients operated on in a single high-volume institution.

Nonspecific, Acute Pouchitis in Patients With Familial Adenomatous Polyposis: Less Common Than We Think.

Background: Nonspecific acute pouchitis is common in patients with ulcerative colitis who undergo IPAA, but there is disagreement about the rate at which this occurs in patients with familial adenomatous polyposis.

Objective: This study aimed to define the rate at which nonspecific acute pouchitis occurs in patients with familial adenomatous polyposis.

Setting: This study was conducted at a hereditary colorectal cancer center in a large academic medical center.