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Redo IPAA for long rectal cuff syndrome after ileoanal pouch for inflammatory bowel disease

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Background

When constructing an ileal pouch-anal anastomosis (IPAA), the rectal cuff should ideally be 1–2 cm long to avoid subsequent complications.

Methods

We identified patients from our IBD center who underwent redo IPAA for a long rectal cuff. Long rectal cuff syndrome (LRCS) was defined as a symptomatic rectal cuff ≥ 4 cm.

Results

Forty patients met the inclusion criteria: 42.5% female, median age at redo surgery 42.5 years. The presentation was ulcerative proctitis in 77.5% of the cases and outlet obstruction in 22.5%. The index pouch was laparoscopically performed in 18 patients (45%). The median rectal cuff length was 6 cm. The pouch was repaired in 16 (40%) cases, whereas 24 (60%) required the creation of a neo-pouch. At the final pathology, the rectal cuff showed chronic active colitis in 38 (90%) cases. After a median follow-up of 34.5 (IQR 12–109) months, pouch failure occurred in 9 (22.5%) cases. The pouch survival rate was 78% at 3 years. Data on the quality of life were available for 11 (27.5%) patients at a median of 75 months after redo surgery. The median QoL score (0–1) was 0.7 (0.4–0.9).

Conclusion

LRCS, a potentially avoidable complication, presents uniformly with symptoms of ulcerative proctitis or stricture. Redo IPAA was restorative for the majority.

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Fig. 1

Data availability

The data, codes, and other materials are available from the corresponding author upon request.

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Funding

This study did not receive any funding.

Author information

Authors and Affiliations

  1. Department of Colon & Rectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44106, USA

    Marianna Maspero, David Liska, Hermann Kessler, Jeremy Lipman, Scott R. Steele, Tracy Hull & Stefan D. Holubar

  2. Department of Gastroenterology, Cleveland Clinic, Cleveland, OH, USA

    Taha Qazi, Florian Rieder & Benjamin Cohen

Authors
  1. Marianna Maspero
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  2. David Liska
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  3. Hermann Kessler
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  4. Jeremy Lipman
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  5. Scott R. Steele
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  6. Tracy Hull
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  7. Taha Qazi
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  8. Florian Rieder
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  9. Benjamin Cohen
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  10. Stefan D. Holubar
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Contributions

Study design: SDH, BC, MM. Data collection, data analysis: MM, DL. Writing, draft: MM, TH. Final manuscript editing: HK, JL, SRS, TQ, FR.

Corresponding author

Correspondence to Stefan D. Holubar.

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Conflict of interest

SDH: consulting fees – Shionogi, Takeda; Research support – Crohn’s & Colitis Foundation, American Society of Colon & Rectal Surgery. The other authors have no conflict of interest related to this publication.

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Maspero, M., Liska, D., Kessler, H. et al. Redo IPAA for long rectal cuff syndrome after ileoanal pouch for inflammatory bowel disease. Tech Coloproctol 28, 38 (2024). https://doi.org/10.1007/s10151-023-02909-9

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  • DOI: https://doi.org/10.1007/s10151-023-02909-9

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