S79 Long Term Outcomes of Straight Ileoanal Anastomoses Converted to Ileal Pouch Anal Anastomoses

Background: While ileal pouch anal anastomosis (IPAA) is the most common and recommended way to restore intestinal continuity after total proctocolectomy, straight ileoanal anastomoses (SIAA) are still selectively performed around the world. In case of SIAA failure, conversion to IPAA is possible, but reports on its outcomes are scarce. Methods: We retrospectively analyzed our prospectively-collected database on pelvic pouches, and identified patients where SIAA was converted to an IPAA. Our aim was to report long-term outcomes and quality of life. Results: Twenty-three patients were included (14 females). All patients underwent SIAA at an outside hospital. The median age was 15 years (IQR 12.5-17) at the index operation, and 19 years (16.5–24) at conversion to IPAA. The patients had their SIAA performed between 1980 and 2017. The indication to SIAA was ulcerative colitis in 17 (74%) cases, indeterminate colitis in 2 (9%) cases, and familial adenomatous polyposis in 4 (17%) cases. The median interval between IAA and IPAA was 4 years (3-6). The indication to conversion to IPAA was incontinence/poor quality of life in 12 (52%) cases, sepsis in 8 (35%) cases (4 fistulas, 3 anastomotic leaks, 1 concomitant fistula and anastomotic leak), anastomotic stricture in 2 (9%) cases, and prolapse in one (4%) case. Thirteen (56%) patients received a J pouch, while 8 (35%) underwent an S pouch, and 2 (9%) a W pouch. Twenty (87%) patients had a handsewn anastomosis. All patients were diverted at IPAA construction. Three (13%) patients never had stoma closure, due to patient wishes, failed healing of vaginal fistula, and pelvic sepsis, respectively. After a median follow-up of 109 months (28-170), pouch failure occurred in 5 additional patients. Pouch survival for patients who achieved stoma closure was 82% at 5 years and 75% at 10 years. Information on quality of life was available for 15 (65%) patients (3 with pouch failure). The median number of bowel movements per day was 8.5. The median quality of life was 8/10 (8-9), quality of health 8/10 (7-8), and quality of energy 7/10 (6-10). The median satisfaction with surgery was 9.5/10 (8-10): all patients would recommend surgery to someone else, while only one patient reported they would not undergo conversion to IPAA again. Conclusion(s): Conversion of SIAA to IPAA leads to acceptable long-term outcomes and good quality of life, and can safely be offered to patients with complications of SIAA.