EP561 - Comparison of 30-Day and Long-Term Outcomes Between Primary K Pouch Creation and J to K Pouch Conversion.

ePoster Presenter(s)

• 

  Amirbahador Abbasi, MD, MPH

  Postdoctoral Research Fellow
  Global Center for Integrated Colorectal Surgery & IBD Interventional Endoscopy Columbia University Irving Medical Center / New York Presbyterian Hospital
  Columbia University Irving Medical Center / New York Presbyterian Hospital
  New York, NY, United States

  Disclosure information not submitted.

Author(s)

• DK

  Dilara Khoshknabi, MD

  Consultant
  Global Center for Integrated Colorectal Surgery & IBD Interventional Endoscopy Columbia University Irving Medical Center / New York Presbyterian Hospital
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• EM

  Erin Testerman Mitra, MSN, RN, CWOCN

  Certified Wound Ostomy Continence Nurse
  NewYork-Presbyterian/ Columbia University Irving Medical Center
  New York, New York, United States

  Disclosure information not submitted.
• VM

  Vanessa Marra, RN, CWOCN

  Certified Wound Ostomy and Continence Nurse
  NYP - Columbia
  New York, New York, United States

  Disclosure information not submitted.
• KA

  Kenneth Autencio, MA, RN, CWOCN

  Clinical Coordinator II
  Outpatient Colorectal surgery
  NY, New York, United States

  Disclosure information not submitted.
• JC

  James M. Church, MD

  Professor of Surgery
  Global Center for Integrated Colorectal Surgery & IBD Interventional Endoscopy Columbia University Irving Medical Center / New York Presbyterian Hospital
  Leola, Pennsylvania, United States

  Disclosure information not submitted.
• BS

  Bo Shen, MD

  Professor of Medicine and Surgical Sciences
  Global Center for Integrated Colorectal Surgery & IBD Interventional Endoscopy Columbia University Irving Medical Center / New York Presbyterian Hospital
  New York, New York, United States

  Disclosure information not submitted.

Senior Author(s)

• RK

  Ravi P. Kiran, MD

  Professor of Surgery
  Global Center for Integrated Colorectal Surgery & IBD Interventional Endoscopy Columbia University Irving Medical Center / New York Presbyterian Hospital
  New York, New York, United States

  Disclosure information not submitted.

Purpose/Background: Conversion of an ileoanal J pouch to a continent ileostomy (K-pouch) is a complex procedure and not an often thought out or offered option to preserve continence and bowel length when J pouch failure occurs. Outcomes of primary K-pouch creation compared with conversion of a failed J-pouch to a K-pouch have not been well characterized. Defining these outcomes is important to guide surgical decision-making and counseling in this complex patient population.

Methods/Interventions: We performed a retrospective review of patients undergoing either primary K-pouch creation or J to K-pouch conversion at a tertiary referral center from 2013 to 2025. Demographics, operative details, 30-day morbidity, and long-term pouch function were compared between groups. Categorical variables were compared using chi-square tests, while depending on the distribution, continuous variables were analyzed using the t-test or Mann-Whitney U test. A p-value of less than 0.05 was considered statistically significant.

Results/Outcomes: A total of 45 patients were included (28 primary K-pouch, 17 J to K conversion). Median age (45.7 vs 44.0 years, p=0.69) and BMI (21.6 vs 24.0 kg/m2, p=0.26) were similar. Ulcerative colitis was the most common indication, though primary K pouch patients also included cancer, constipation, and Crohn's disease (p=0.02). Operative time (295 vs 292 minutes, p=0.68) and blood loss (200 vs 200 mL, p=0.41) were comparable. At 30 days, length of stay (8 vs 8 days, p=0.42), readmission (28.6% vs 29.4%, p=1.00), reoperation (0% vs 5.9%, p=0.38), and mortality (0% in both) were similar. Ileus (39.3% vs 41.2%, p=0.90), abscess (14.3% vs 11.8%, p=1.00), and transfusion (21.4% vs 35.3%, p=0.33) did not differ significantly.

With median follow-up of 44 vs 35 months, pouch survival was high in both groups (82.1% vs 88.2%, p=0.69). Revision rates (35.7% vs 17.6%, p=0.31) and pouch failure (17.9% vs 11.8%, p=0.69) trended higher in the primary K-pouch group but were not statistically significant.

Conclusion/Discussion: Conversion of a J to a K pouch achieves excellent pouch survival and comparable 30-day morbidity to primary K pouch creation supporting this as an effective salvage option to preserve continence and conserve small bowel when J-pouch failure occurs.

Table 1: Characteristics and Outcomes of Primary K Pouch vs. J to K Pouch Conversion Groups.
BMI, body mass index; FAP, familial adenomatosis polyposis; IQR, interquartile range; LOS, length of stay; PONV, postoperative nausea and vomiting; SSI, surgical site infection; UC, ulcerative colitis.