The following is a summary of “Salvage Surgery: An Effective Therapy in the Management of Ileoanal Pouch Prolapse” published in the January 2024 issue of Gastroenterology by Otero-Piñeiro, et al.

Restorative proctocolectomy with IPAA is the best surgery for people with IBD and, less often, other diseases that need surgery. Pouch slippage is a rare problem that makes the pouch less useful and lowers the quality of life for patients. For a study, researchers sought to explain what they saw from a single high-volume center during this rare event. The success rate of pouch pexy, is described as no leakage happening again.

IPAA was done on 4,791 patients, and 7 (0.1%) were found to have full-thickness prolapse. A further 18 patients with full-thickness prolapse who underwent IPAA were sent from other hospitals. The average age of the 25 cases was 35.6 years, with a range of 13.4 years. 16 of them were women (64.0%). The time between the first pouch formation and collapse was 4.2 years (interquartile range, 1.1 to 8.5 years). About 9 patients (36.0%) had been treated for prolapse before. All of the patients had symptoms and a physical test that pointed to full-thickness prolapse.

About 20 patients (80.0%) had surgical pouch pexy without mesh, and five patients (20.0%) had surgical pouch pexy with mesh. One patient (4.0%) had a redirecting ileostomy done before the pouch pexy, and eight patients (32.0%) had one done when the prolapse was fixed surgically. Recurrent prolapse was seen in 3 patients (12.0%) after surgery, with a median time of 6.9 months (interquartile range, 5.2–8.3). It was a retrospective study with a small sample size, which made it easy for selection biases to happen. Referral biases may also make it harder to use their results in other situations. In conclusion, rescue surgery is an excellent way to treat pouch prolapse. Having surgery is safe and usually results in good results.

Source: journals.lww.com/dcrjournal/abstract/2024/01000/salvage_surgery__an_effective_therapy_in_the.16.aspx