Hand-Sewn Versus Stapled Ileal Pouch Anal Anastomoses in Re-Do Setting: Indications, Patient Characteristics, Operative, Functional and Quality of Life Outcomes.

BACKGROUND Impact of the type of anastomosis on the outcomes of re-do ileal pouch anal anastomosis (IPAA) is unknown. OBJECTIVE The aim of this study is to assess the indications, peri-operative and functional outcomes in patients undergoing stapled vs hand-sewn re-do IPAA. DESIGN This is a retrospective cohort study. SETTINGS This investigation is based on a single-academic practice group experience on re-do IPAA. PATIENTS Patients who underwent re-do IPAA for ileal pouch failure between 09/2016 - 05/2020 were included in the study. MAIN OUTCOME MEASURES Indications, perioperative, functional outcomes, restrictions and quality of life scores were compared between stapled and hand-sewn groups. RESULTS A total of 105 patients underwent re-do IPAA for ileal pouch failure of whom 76 (72%) had hand-sewn and 29 (28%) had stapled re-anastomosis. The interval between the index and re-do IPAA was shorter in stapled re-do IPAA [median (IQR), Stapled: 3 years (1-4) vs hand-sewn: 7 years (3-17), p 0.05). LIMITATIONS This study is limited by its low study power and limited follow-up time. CONCLUSIONS Patients who had pelvic sepsis after their index IPAA required hand-sewn anastomosis at higher rate than other re-do cases. Although hand-sewn anastomosis is a more complex procedure, it was associated with similar morbidity, functional outcomes and quality of life scores compared to stapled anastomosis for re-do IPAA. See Video Abstract at http://links.lww.com/DCR/B580.