EP302 - Re-do ileal pouch anal anastomosis can safely be performed in patients with dysplasia/neoplasia

Sunday, May 11, 2025

9:05 AM – 9:10 AM PT

Location: Monitor 6, Sails Pavilion, Upper Level

ePoster Presenter(s)

Eren Esen, MD

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

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This individual has no financial relationships with ineligible companies.

Author(s)

Mehmet Gulmez, MD

Surgeon
Northwell
New york, New York, United States

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Ad

Andre da Luz Moreira, MD, PhD

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

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AE

Arman Erkan, MD

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

Disclosure information not submitted.
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.

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

Mehmet Gulmez, 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: Neoplasia is a rare complication after ileal pouch anal anastomosis (IPAA). Surveillance pouchoscopy may detect neoplasia in patients with failed IPAA and these patients may be salvaged with re-do IPAA. Literature regarding neoplasia as a finding during re-do IPAA is scarce. We evaluated our database for patients who had re-do IPAA with findings of neoplasia in the primary IPAA.

Methods/Interventions: We included all patients who had re-do IPAA between 9/2016 and 12/2023. We reported indications and short- and long-term outcomes after re-do IPAA for failed IPAAs with neoplasia.

Results/Outcomes: We included 258 patients who had re-do IPAA. Of those, 6 of them had neoplasia (2.3%). Diagnoses were UC (n=3) and FAP (n=3). Two patients had high grade dysplasia, 2 patients had multifocal low grade dysplasia, 1 patient had invasive adenocarcinoma and 1 patient had desmoid tumor. Three patients had polypoid lesions and adenomas originating from the rectal mucosa, one patient had lesions in the anal transition zone, and one patient had multiple tubulovillous adenomas invading toward the J pouch. The desmoid tumor was located in the presacral area. Five patients had long rectal cuff intraoperatively. All pouches were J configuration. Existing pouch was resected in 5 patients and preserved in 1 patient. Mucosectomy and handsewn anastomosis was performed in 4 patients. All patients were alive and preserved their pouches in median 2 year follow-up.

Conclusion/Discussion: Re-do IPAA is associated with high success rates in the setting of neoplasia. Long rectal cuff at the index operation may be a predisposing factor for development of neoplasia. Annual surveillance may help detecting patients with neoplasia.