EP301 - Pouch Configuration Changes in Redo IPAA Surgery: Insights from a Quaternary IBD Center

Sunday, May 11, 2025

9:00 AM – 9:05 AM PT

Location: Monitor 6, Sails Pavilion, Upper Level

ePoster Presenter(s)

Mehmet Gulmez, MD

Surgeon
Northwell
New york, New York, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Eren Esen, MD

Surgery Resident
NYU Langone Health
New York, New York, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Hinduja Pranav, M.B.B.S

Resident
Brookdale hospital
Brooklyn, New York, United States

Disclosure information not submitted.
MG

Michael J. Grieco, MD

Associate Professor of Surgery
NYU Langone Health
New York, New York, United States

Disclosure information not submitted.
AE

Arman Erkan, MD

Associate Professor of Surgery
Northwell Health
New York, New York, United States

Disclosure information not submitted.
Ad

Andre da Luz Moreira, MD, PhD

Clinical Associate Professor of Surgery
NYU Grossman School of Medicine
New York, New York, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

FR

Feza H. Remzi, MD, FACS, FTSS (Hon)

Vice President, Center for Advanced Inflammatory Bowel Disease Care
Donald and Barbara Zucker School of Medicine, Northwell Health
Manhasset, New York, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Mehmet Gulmez, MD: This individual has no financial relationships with ineligible companies.

Eren Esen, MD: This individual has no financial relationships with ineligible companies.

Andre da Luz Moreira, MD, PhD: This individual has no financial relationships with ineligible companies.

Feza H. Remzi, MD, FACS, FTSS (Hon): This individual has no financial relationships with ineligible companies.

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Purpose/Background: Redo ileal pouch-anal anastomosis (IPAA) is a technically challenging procedure, performed in patients with pouch failure or dysfunction. The success of redo IPAA often depends on the surgeon’s ability to manage various pouch configurations, as conversion from one type of pouch to another may be required. While the J pouch is the most commonly used configuration, alternatives such as the H pouch and S pouch are sometimes employed in redo IPAA. This study reviews pouch configuration changes in patients undergoing redo IPAA and highlights the importance of surgical expertise in optimizing outcomes through the use of different pouch types.

Methods/Interventions: We conducted a retrospective review of medical records from 258 patients who underwent redo IPAA surgery at our inflammatory bowel disease (IBD) center between September 2016 and December 2023. We identified patients who had a change in pouch configuration during their redo surgery and categorized these conversions. We analyzed the clinical factors associated with changes from J pouch to H pouch, S pouch to J pouch, and J pouch to S pouch.

Results/Outcomes: Of the 258 patients, 14 (5.4%) underwent a pouch configuration change during redo IPAA surgery. Pouch conversion from J pouch to H pouch occurred in 6 patients, from S pouch to J pouch in 5 patients, and from J pouch to S pouch in 3 patients. The main reason for converting J pouches to H pouches was a narrow pelvis or prior ileostomy site, while reach issues necessitated the creation of S pouches after excision of previous J pouches. Mechanical indications were present in 12 (86%) patients, and septic indications in 10 (71%). Major postoperative complications, including pelvic abscess, leak, fistula, or reoperation, occurred in 2 patients within 30 days. At a median follow-up of 28 months, 4 (29%) patients experienced pouch failure, all of whom had undergone conversion from J pouch to H pouch. Among patients with functioning pouches, 8 (80%) responded to the questionnaire, with all indicating they would recommend surgery to others and undergo the procedure again if needed.

Conclusion/Discussion: This study highlights the complexity of redo IPAA surgery and the critical role of surgical expertise in managing multiple pouch configurations. The ability to adapt between J, H, and S pouches is crucial, as patient anatomy and prior surgical outcomes often dictate the need for conversion. Surgeons performing redo IPAA must be proficient in the nuances of each pouch type to warrant favorable outcomes. These findings emphasize the importance of advanced surgical training and experience in successfully managing the complexities of redo IPAA surgery.