Aim
To assess short‐ and long‐term outcomes of redo ileal pouch‐anal anastomosis (redo‐IPAA) for failed IPAA, comparing them with those of successful IPAA.
Method
This was a case–control study. Data were collected retrospectively from prospectively maintained databases from two tertiary care centres. Patients who had a redo‐IPAA between 1999 and 2016 were identified and matched (1:2) with patients who had a primary IPAA (p‐IPAA), according to diagnosis, age and body mass index.
Results
Thirty‐nine redo‐IPAAs (16 transanal and 23 abdominal procedures) were identified, and were matched with 78 p‐IPAAs. After a mean follow‐up of 56 ± 51 (2.6–190) months, failure rates after transanal and abdominal approaches were 50% and 15%, respectively. Reoperation after the transanal approach was higher than after p‐IPAA (69% vs 7%; P < 0.001). No differences were noted between the abdominal approach for redo‐IPAA and p‐IPAA in terms of morbidity (61% for redo‐IPAA vs 38% for p‐IPAA; P = 0.06), major morbidity (9% vs 8%; P = 0.96), anastomotic leakage (13% vs 10%; P = 0.74), mean daily bowel movements (6 vs 5.5; P = 0.68), night‐time bowel movements (1.2 vs 1; P = 0.51), faecal incontinence (13% vs 7%; P = 0.40), urgency (31% vs 27%; P = 0.59), use of anti‐diarrhoeal drugs (47% vs 37%; P = 0.70), mean Cleveland Global Quality‐of‐Life score (7 vs 7; P = 0.83) or sexual function.
Conclusion
The abdominal approach for redo‐IPAA is justified in cases of pouch failure because it achieves functional results comparable with those observed after p‐IPAA, without higher postoperative morbidity. The transanal approach should be chosen sparingly.