Long Rectal Cuff and Remnant Mesorectum Are Major Preventable Causes of Ileal Pouch Failure

BACKGROUND: Long rectal cuff (>2 cm) and remnant mesorectum are known causes of pouch dysfunction due to obstructive defecation, as well as pelvic sepsis after prolonged obstruction. OBJECTIVE: The aim of this study is to report the rates and the management of patients who underwent re-do ileal pouch anal anastomosis due to pouch failure associated with retained mesorectum and long rectal cuff. DESIGN: This is a retrospective study. SETTINGS: The investigation is based on a quaternary inflammatory bowel disease center. PATIENTS: Patients undergoing re-do ileal pouch anal anastomosis surgery and had long rectal cuff and/or remnant mesorectum between September 2016 and September 2023 were included in the study. MAIN OUTCOME MEASURES: The main outcomes were functioning pouch rate and functional results. RESULTS: Of the 245 patients who underwent re-do ileal pouch anal anastomosis surgery, 98 (40%) patients had long rectal cuff and/or remnant mesorectum. Re-do ileal pouch anal anastomosis in this patient group was successful (92%) at a median follow-up of 28 (18-52) months. LIMITATIONS: The retrospective nature of the study and this is the experience of a single specialized center. CONCLUSIONS: Long rectal cuff and remanent mesorectum are major causes of pouch failure which can be successfully managed with re-do ileal pouch anal anastomosis surgery. Nearly half of pouch failure patients who had successful re-do ileal pouch anal anastomosis surgery initially received unnecessary biologic therapy before coming to our center. See Video abstract .