Pouch prolapse is an uncommon but challenging complication following ileal pouch–anal anastomosis, often resulting from excessive pouch mobility and redundancy. We present the case of a 19-year-old female with ulcerative colitis who developed a 2-cm full-thickness pouch prolapse associated with worsening urgency after a staged proctocolectomy. Diagnostic laparoscopy demonstrated a redundant, highly mobile pouch. A combined laparoscopic and transperineal approach was used to achieve circumferential mobilization of the pouch while preserving the internal sphincter. The redundant distal pouch was excised, and a new hand-sewn pouch–anal anastomosis was created with confirmation of adequate perfusion using indocyanine green fluorescence. After repair of a small air leak and verification of proper pouch orientation, a diverting loop ileostomy was constructed to protect the anastomosis (Video 1). Management of pouch prolapse should be individualized and guided by symptom severity and anatomic findings. Full-thickness prolapse frequently necessitates surgical correction. While transabdominal pouch-pexy remains a well-described approach, redo pouch–anal anastomosis with resection of redundant bowel may be particularly suitable for short-segment prolapse, as it restores normal anatomy while preserving pouch function in carefully selected patients. This technique underscores the importance of correcting pouch redundancy while maintaining proper orientation to optimize functional outcomes. Maher Al Khaldi: Conceptualization; methodology; data curation; writing – original draft; visualization. Timothy Holleran: Data curation; visualization; writing – review and editing. Zubair Bayat: Data curation; visualization; writing – review and editing. Marcus Oosenbrug: Visualization; data curation; writing – review and editing. Steven D. Wexner: Conceptualization; project administration; supervision; writing – review and editing. Steven D. Wexner is a consultant for ActivSurgical, Arthrex, Baxter, Becton, Dickinson and Co., Glaxo Smith Kline, Intuitive Surgical, Ostomy Secure, Polypid, Seikagaku and Takeda, receives stock options for consulting from Polypid and OstomyCure and receives royalties from Intuitive Surgical, Karl Storz Endoscopy America Inc. and Unique Surgical Solutions, LLC. Maher Al Khaldi, Timothy Holleran, Zubair Bayat, and Marcus Oosenbrug do not report any conflicts of interest. All authors have no conflict of interest. This video recording was deemed exempt from ethics approval as the patient gave informed consent. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
Khaldi et al. (Wed,) studied this question.