Intraoperative Abandonment of Ileal Pouch to Anal Anastomosis

Intraoperative Abandonment of Ileal Pouch to Anal Anastomosis—The Mayo Clinic Experience

Presented at the American College of Surgeons 83rd Annual Clinical Congress, Chicago, October 1997.
Scott M. Browning MD^AA and Santhat Nivatvongs MD, FACS^A

^A Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN USA.
^A Scott M. Browning, MD, Department of General Surgery (MKSG), Wilford Hall Medical Center (59th MDW), 2200 Bergquist Drive, Suite 1, Lackland AFB, TX 78236. \ %
Manuscript received 23 October 1997 Accepted 23 October 1997;

Background: Completion of the ileal pouch to anal anastomosis (IPAA) is neither always possible nor advisable based on intraoperative findings. This study was undertaken to document the incidence of and reasons for intraoperative abandonment of IPAA in a series of over 1,700 attempts.

Study Design: A retrospective review of the Mayo Clinic surgical index from January 1981 through December 1995. Patients with the preoperative diagnosis of chronic ulcerative colitis or familial adenomatous polyposis for whom IPAA was planned but not completed are the subject of this report. Comparison is made to patients with a completed IPAA from the Mayo Clinic IPAA registry.

Results: During a 15-year period, 1,789 IPAA attempts were made. Intraoperative abandonment occurred in 74 (4.1%). Patients in whom the operation was abandoned were older than patients in whom it was not (38 versus 33 years, p < 0.01), with age older than 40 years conferring a relative risk of 1.87 versus age younger than 40 (95% confidence interval, 1.19–2.94%). IPAA was abandoned for technical reasons in 32 (43%), intraoperative diagnosis of Crohn's disease in 27 (36%), colorectal cancer in 10 (14%), mesenteric desmoid in 3 (4%), and miscellaneous reasons in 2 (3%) patients. Fifty-one (69%) patients underwent proctocolectomy and ileostomy and 23 (31%) underwent sphincter preserving procedures. Of these, 2 underwent subsequent successful IPAA.

Conclusions: Preoperative counseling for IPAA should include discussion of the risk of intraoperative abandonment (4.1%). Older patients are at increased risk. If the IPAA is abandoned for reversible reasons, preservation of the anal sphincter preserves the option of a subsequent IPAA.

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