#26 Optimal Shape of Ileal Pouch

Study #26

This was a result of realizing that an S pouch would fit nicely into a mucosectomized anus and a J pouch onto a stapled off anus. This concept, of a stapled J and a hand-sewn S, would make outcomes of pouch surgery significantly better.

Wu XR; Kirat HT; Kalady MF; Church JM. Restorative Proctocolectomy With a Handsewn IPAA: S-Pouch or J-Pouch?. Dis Colon & Rectum. 2015; 58: 205-13.

Background: The efferent limb on the S-pouch fits well into the anal canal while the body of the pouch lies on the levators. In contrast, the blunt end of a J-pouch may be distorted as it is forced into the muscular tube of the stripped anus.

Objective: The aim of this study is to compare the clinical outcomes and quality of life between patients with S- and J-pouches with a handsewn IPAA.

Design: This study was retrospective.

Setting: This study was conducted at a high-volume tertiary referral center.

Patients: Patients undergoing a primary handsewn IPAA from 1983 to 2012 were identified.

Main outcomes measures: Demographics, operative details, functional outcomes, and quality of life were abstracted.

Results: A total of 502 patients, including 169 patients with an S-pouch (33.7%) and 333 patients with J-pouch (66.3%), met our inclusion criteria; 55.8% (n = 280) were men. Mean age at pouch construction was 37.8 ± 12.5 years. Patients with an S-pouch were younger (p = 0.004) and had a higher BMI (p = 0.035) at pouch surgery. There was no significant difference between patients with S- or J-pouches in other demographics. The frequencies of short-term complications in the 2 groups were similar (p > 0.05), but pouch fistula or sinus (p = 0.047), pelvic sepsis (p = 0.044), postoperative partial small-bowel obstruction (p = 0.003), or postoperative pouch-related hospitalization (p = 0.021) occurred in fewer patients with an S-pouch. At a median follow-up of 12.2 (range, 4.3-20.1) years, patients with an S-pouch were found to have fewer bowel movements (p < 0.001), less frequent pad use (p = 0.001), and a lower fecal incontinence severity index score (p = 0.015). The pouch failed in 62 patients (12.4%), but neither univariate nor multivariate analysis showed a significant association with pouch configuration.

Limitations: The use of data from a single tertiary referral center was a limitation of this study.

Conclusion: We recommend using an S-pouch when constructing an IPAA with a handsewn technique.