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Session: ePoster: IBD 1 (Sun8)

EP304 - Routine diversion following IPAA construction may not be necessary – retrospective analysis from a Canadian institution

Sunday, May 11, 2025
9:16 AM – 9:21 AM PT
Location: Monitor 6, Sails Pavilion, Upper Level

    Author(s)

  • CV

    Carlos Verdiales, MD

    General Surgery Resident
    University of Saskatchewan
    Saskatoon, Saskatchewan, Canada

    Disclosure information not submitted.

    • ePoster Presenter(s)

  • Zarrukh Baig, MD MPH FRCSC

    Colorectal Surgery Fellow
    St. Paul's Hospital -Vancouver
    Vancouver, BC, Canada

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

    • Author(s)

  • MW

    Marley Wacker, MD

    General Surgery Resident
    University of Saskatchewan
    Saskatoon, Saskatchewan, Canada

    Disclosure information not submitted.

  • HR

    Haven Roy, MD FRCSC

    Colorectal Surgeon
    University of Saskatchewan
    Saskatoon, Saskatchewan, Canada

    Disclosure information not submitted.

  • DG

    David Nathan Ginther, MD FRCSC FACS

    Colorectal Surgeon
    University of Saskatchewan
    Saskaton, Saskatchewan, Canada

    Disclosure information not submitted.

    • Senior Author(s)

  • DG

    Dilip Gill, MD FRCSC

    Colorectal Surgeon
    University of Saskatchewan
    Saskatoon, Saskatchewan, Canada

    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.
Zarrukh Baig, MD MPH FRCSC: This individual has no financial relationships with ineligible companies.
Dilip Gill, MD FRCSC: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Ileal pouch-anal anastomosis (IPAA) is a surgical option for patients with ulcerative colitis, synchronous cancers, and certain genetic syndromes that predispose individuals to colorectal cancer. Traditionally, the surgery has been performed using either a 2-stage or 3-stage approach, involving the creation of a diverting ileostomy to protect the newly formed pelvic pouch. Recently, the modified 2-stage has found renewed interest, which includes subtotal colectomy followed by pouch creation without a diverting ileostomy. This technique eliminates the need for additional surgery to reverse the ileostomy, but it also presents the potential risk of complications such as pelvic sepsis associated with a non-diverted pouch. Current literature offers mixed conclusions about the safety and outcomes of non-diverted pouches for patients with ulcerative colitis.

Methods/Interventions: This study retrospectively reviewed both diverted and non-diverted IPAA procedures at a high-volume Canadian academic center performed by two fellowship-trained colorectal surgeons. The review analyzed 51 patients who underwent IPAA between 2018 and 2022, of whom 26 received a non-diverted pouch. The remaining 25 patients had conventional diverted pouch surgeries, with follow-up data for 22 cases. Key outcomes such as length of hospital stay, postoperative complications (Clavien-Dindo 2 or higher), 30-day readmission rates, and the risk of conversion to open surgery were examined.

Results/Outcomes: There was no significant difference between the length of stay after the first or second operation (p=0.825 and p=0.63, respectively). The total length of stay was only marginally better for the non-diverted pouches (0.41 days less, p=0.006). There was a 2-fold risk of converting to open surgery in the conventional diverted pouch group. There was a 12-fold risk of readmission within 30 days in the conventional group. There was no significant difference in the risk of Clavien-Dindo 2 or higher complications (4 vs. 5, p=0.013). There were no anastomotic leaks in either group.

Conclusion/Discussion: This study compared outcomes between non-diverted and diverted ileal pouch-anal anastomosis (IPAA) procedures. Results showed that non-diverted pouches had a slightly shorter total hospital stay and significantly lower risks of conversion to open surgery and 30-day readmission. However, there was no significant difference in complication rates between the two groups, suggesting that non-diverted pouches may offer a safe alternative without increasing postoperative risk.