Salvage surgery effective treatment alternative for J-pouch afferent limb stricture

All consecutive eligible patients with ileal pouch–anal anastomosis and afferent limb stricture were identified from our institutional review board–approved database from 1990 to 2021. Patients surgically treated with excision and reimplantation/strictureplasty of afferent limb stricture were included in this study.

Results

Twenty patients met our inclusion criteria. Fifteen (75%) were female, and the overall mean age was 41 ± 10.3 years at afferent limb stricture surgery. The interval from ileal pouch–anal anastomosis formation to surgery for afferent limb stricture was 13.5 ± 6.7 years. Nine (45%) underwent strictureplasty, and 11 (55%) had resection and reimplantation of the afferent limb into the pouch. Before afferent limb stricture surgery, 3 (15%) required a diverting ileostomy for their obstructive symptoms. An additional 12 (60%) had a stoma constructed during afferent limb stricture surgery, and 5 had a strictureplasty and no stoma. Postoperatively, 1 patient (5%) had a leak at the afferent limb stricture repair site. All patients had their ileostomy closed 3.2 (2.99–3.6) months after surgery. Long-term after afferent limb stricture surgery, recurrent small bowel obstruction symptoms recurred in 7 (35%) patients 3.9 (2.6–5.8) years later.

Afferent limb stricture can be treated effectively with salvage surgery. The surgical intervention appears durable and provides an acceptable outcome for their obstructive symptoms.

Reference:

Ana M. Otero-Piñeiro, Crina Floruta, Marianna Maspero, Jeremy M. Lipman, Stefan D. Holubar, Scott R. Steele, Tracy L. Hull, Salvage surgery is an effective alternative for J-pouch afferent limb stricture treatment, Surgery, Volume 174, Issue 4, 2023, Pages 753-757, ISSN 0039-6060,. https://doi.org/10.1016/j.surg.2023.03.006.

(https://www.sciencedirect.com/science/article/pii/S0039606023001289)

Keywords:

Salvage, surgery, effective, treatment, alternative, J-pouch, afferent, limb, stricture, surgery, Ana M. Otero-Piñeiro, Crina Floruta, Marianna Maspero, Jeremy M. Lipman, Stefan D. Holubar, Scott R. Steele, Tracy L. Hull