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Is Conversion of a Failed IPAA to a Continent Ileostomy a Risk Factor for Long-term Failure?

Aytac, Erman, M.D.1,2; Dietz, David W., M.D.1,3; Ashburn, Jean, M.D.1,4; Remzi, Feza H., M.D.1,5

doi: 10.1097/DCR.0000000000001277
Original Contributions: Inflammatory Bowel Disease
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BACKGROUND: A continent ileostomy may be offered to patients in hopes of avoiding permanent ileostomy. Data on the outcomes of continent ileostomy patients with a history of a failed IPAA are limited.

OBJECTIVE: This study aimed to assess whether a history of previous failed IPAA had an effect on continent ileostomy survival and the long-term outcomes.

DESIGN: This was a retrospective cohort study.

SETTINGS: This investigation took place in a high-volume, specialized colorectal surgery department.

PATIENTS: Patients who underwent continent ileostomy construction after IPAA failure between 1982 and 2013 were evaluated and compared with patients who have no history of IPAA surgery.

MAIN OUTCOME MEASURES: Functional outcomes and long-term complications were compared.

RESULTS: A total of 67 patients fulfilled the case-matching criteria and were included in the analysis. Requirement of major (52% vs 61%; p = 0.756) and minor (15% vs 19%; p = 0.492) revisions were comparable between patients who had continent ileostomy after a failed IPAA and those who had continent ileostomy without having a previous restorative procedure. Intubations per day (5 vs 5; p = 0.804) and per night (1 vs 1; p = 0.700) were similar in both groups. Our data show no clear relationship between failure of continent ileostomy and history of failed IPAA (p = 0.638). The most common cause of continent ileostomy failure was enterocutaneous/enteroenteric fistula (n = 14). Six patients died during the study period because of other causes unrelated to continent ileostomy.

LIMITATIONS: This study was limited by its retrospective and nonrandomized nature.

CONCLUSIONS: Converting a failed IPAA to a continent ileostomy did not worsen continent ileostomy outcomes in this selected group of patients. When a redo IPAA is not feasible, continent ileostomy can be offered as an alternative to conventional end ileostomy in highly motivated patients. See Video Abstract at

1 Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio

2 Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey

3 Division of Colorectal Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio

4 Department of General Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina

5 Division of Colorectal Surgery, Department of Surgery, New York University, Langone Medical Center, New York, New York

Funding/Support: None reported.

Financial Disclosure: None reported.

Poster presentation at Digestive Disease Week, San Diego, CA, May 21 to 24, 2016.

Correspondence: David W. Dietz, M.D., University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106. E-mail:

© 2019 The American Society of Colon and Rectal Surgeons