Surgical Management of the Complex Crohn’s and Ulcerative Colitis Patient: When to Redo a Pouch

With the increasing complexity in the management of inflammatory bowel disease (IBD) patients, the surgeon’s role has transitioned from a last-resort consultant to an early active member of the treatment team. To avoid morbidity and optimize outcomes, an IBD surgeon should be involved whenever patients require admission for IBD, when a second biologic is started, or early in the course of ulcerative colitis (UC) to explain the surgical option of an ileal pouch-anal anastomosis (IPAA). We advocate for IBD sub-specialization of colorectal surgeons because IBD surgery, especially pouch and redo pouch surgery, is a complex procedure with potential complications that can compromise patients’ quality of life. Expertise and resources are fundamental to optimize pouch longevity, and a multidisciplinary team is needed to treat pouch failure from mechanical complications, rather than labeling the pouch as having Crohn’s disease. In this chapter we discuss the different indications for surgery in IBD patients with particular emphasis on pouch surgery, workup and treatment for redo pouch surgery, and surgical outcomes and complications.