P281 Conversion of the ileal pouch-anal anastomosis to a continent ileostomy – outcome and patient satisfaction
Hermanson, M.(1)*;Bengtson, J.(1);Block, M.(1);
(1)Sahlgrenska University Hospital/Östra, Department of Surgery, Gothenburg, Sweden;
Background
This is a description of consecutive patients converted from ileal pouch-anal anastomosis (IPAA) to continent ileostomy (CI) at a tertiary centre, outcome after surgery and patient satisfaction after long time follow-up.
Methods
All consecutive patients operated with IPAA which later was converted to a CI at Sahlgrenska University Hospital, Gothenburg, Sweden, were included in the study. Demographic data was registered and a questionnaire regarding quality of life was sent to included patients.
Results
A total of 28 patients were included during the period of 1985-2022. The most common diagnosis was Ulcerative Colitis (UC) (n=23), other diagnoses included Crohn´s disease (n=2) and Familial Adenomatous Polyposis (n=1) (missing data n=2). IPAA was performed at a mean age of 30 (15-49) years and IPAA converted to CI at a mean age of 39 (22-62) years. At follow-up, three of the patients were diseased, not related to conversion surgery, and one had moved abroad. All of the remaining 24 patients completed the questionnaire. 20/28 (71%) patients still had their CI in function. 17/28 (61%) were converted due to fistula problems and the rest due to functional problems. 20/28 (71%) were converted using their IPAA-pouch and 4/28 (14%) had a new-constructed reservoir (missing data n=4). Totally, 18/20 (90% p<0.001) were satisfied with the CI and 19/20 (95% p<0.001) would choose it again if they were facing the same situation, even if most of the patients needed revision of the reservoir (mean 2 (0-5) surgeries). Four patients required excision of the CI. All excised patients had UC and was converted using their original IPAA. The main reason for conversion in the excised group was fistula with the inner meatus in the IPAA (three woman with anovaginal fistula and one man with perianal fistula).
Conclusion
A CI is an alternative that patients seem to be satisfied with, even after long follow-up time, when IPAA is no longer a suitable alternative. The majority of the patients in this study were converted from IPAA to CI using their IPAA-pouch.