EP401 - Conversion of Barnett continent reservoir to Koch reservoir: A 30-Year Retrospective Study on Surgical Outcomes and Long-Term Follow-Up

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Purpose/Background: The Barnett continent reservoir has long been used as a surgical option for patients requiring continent ileostomies, but complications such as valve leakage, bowel obstruction, and pouch failure often necessitate revisions. Conversion to a Kock (K) pouch offers an alternative that still preserves continence. This study aims to evaluate the safety and effectiveness of converting Barnett pouches to K-pouch by analyzing long-term outcomes, including pouch salvage and failure rates, in patients undergoing this procedure. We hypothesized K-pouches, compared to B-pouches, are associated with increased long-term pouch survival

Methods/Interventions: This retrospective cohort study included Barnett pouch patients who underwent conversion to K-pouch (B-to-K group) and who did not undergo conversion (B group) between 1991 and 2024. Conversion technique consisted of disconnection of afferent limb from Barnett reservoir, preservation of ileal reservoir itself and rotating it 180 degrees, resection of collar valve and creation of new nipple valve by invaginating 12 cm of ileum and securing it with three fires of non-cutting transverse stapler and finally creating the handsewn end-to-end anastomosis between the pouch and neo-afferent limb. Patients were included if they had at least one revision due to complications. Data on demographics, surgical history, and long-term follow-up were collected. Pouch salvage was defined as retaining a continent pouch post-conversion, while pouch failure was defined as excision and permanent end ileostomy. All Barnett pouches were performed at an outside hospital and referred to our center for longitudinal care. Statistical comparisons were made using chi-square tests for categorical variables and t-tests for continuous variables. Statistical significance was set at p< 0.05

Results/Outcomes: Of the 30 patients with Barnett included, 16 underwent conversion to a K-pouch, while 14 did not. The median age was 51.5 (IQR: 46.5–62.2) years in conversion group and 60.5 (53-65) years in non-conversion, 62.5% and 57.1% were female, and the median body mass index was 24.7 (23.1—27.6) and 22.3 (21.4-24.4) kg/m² in conversion group and non-conversion, respectively. The primary surgical indication was ulcerative colitis (62.6% vs 78.8%), followed by Crohn’s disease (25% vs 14.3%). The leading causes for revision were valve slippage (50% vs 35.7%) and fistula (18.7% vs 28.6%). The median time from Barnett pouch construction to K-pouch conversion was 27.3 (22.8–44.1) years, and the median time from Barnett pouch construction to the first revision was 10.9 (9.1 – 17.8) and 21.2 (8.8 - 26) years in the converted group and non-converted group respectively. Kaplan-Meier survival analysis for all patients showed that 60% retained continent pouches at the end of the follow-up period, while the remaining experienced pouch excision, indicating an overall failure rate of 40%. Pouch salvage was significantly higher in the conversion group, with 81.3% (13/16) retaining functional pouches, compared to 35.7% (5/14) in the non-conversion group (p=0.03)

Conclusion/Discussion: The conversion of Barnett pouch to K-pouch significantly improves the likelihood of pouch salvage and reduces the risk of pouch failure. This study demonstrates that loss of continence in collar mechanism of Barnett reservoir can be addressed by creating new stapled valve and converting Barnett reservoir to Koch pouch. This is complex procedure requiring experience and can be safely offered to patients motivated to avoid having a permanent end ileostomy