EP135 - Outcomes of Pouch Excisions: A Single Center Retrospective Study

Purpose/Background: Ileoanal pouch excision is a complex and technically demanding procedure typically performed following failure of restorative proctocolectomy. Data on long-term outcomes remains limited. This study aims to review the indications, perioperative outcomes, and postoperative complications following pouch excision at a single tertiary care center.

Methods/Interventions: Following IRB approval, a retrospective review was conducted of patients who underwent ileoanal pouch excision between August 2010 and March 2025. Collected variables included patient demographics, ASA score, indication for pouch creation and excision, duration of time with pouch, surgical approach, type of pouch, postoperative complications, length of stay, and mortality rate. Our primary aim was to evaluate early ( < 30-day) and late (>30-day) complication rates.

Results/Outcomes: Fifty-three patients were included, of whom 28 (53%) were female. The average age was 49.6 years (± 13.9). Seven patients (13%) underwent urgent surgery while forty-six (87%) were elective. The primary indication for pouch creation was ulcerative colitis (71%), followed by familial adenomatous polyposis (19%). Forty-nine (92%) received a J pouch, and four (7.5%) a S pouch configuration. The average duration between pouch creation and excision was 15 years (±11), The most common indications for excision were fistula (n=27, 51%), and stricture (n=14, 26%), followed by malignancy (n=6, 11%), and pelvic abscess (n=6 patients, 11%). Twenty-two patients were diagnosed with Crohn's disease (42%) prior to pouch excision. No perioperative mortalities were observed. Early complications were common (n=22, 42%), encompassing delayed wound healing, intra-abdominal abscess, superficial site wound infections, small bowel obstructions, and readmission for ileus. The most common early complication was intra-abdominal abscess (n=10, 19%). Five (9%) patients required operative intervention. Late complications were also common (n=22, 42%) and included delayed wound healing, parastomal hernia, stoma dysfunction, small bowel obstruction, urinary or sexual dysfunction, or high output ileostomy. Stomal complications were the most common late complication, occurring in seven patients (13.2%).

Conclusion/Discussion: Pouch excision was most commonly performed for fistula and stricture, many of which carried a diagnosis of Crohn's disease. Although no mortality was observed, the procedure carried significant morbidity with early and late complications affecting over 40% of patients. These findings highlight the complex nature of pouch excision and the importance of multidisciplinary management, meticulous perioperative care, and long-term follow-up to optimize outcomes.Table 2: Post Operative Complications
Complications of Pouch excisions
Table 1: Patient Demographics
General demographic information of the patients undergoing pouch excision