Reoperative pouch surgery for suspected Crohn's-related complications aided by biologic coverage: Early experience from an inflammatory bowel disease center.

Aim: In patients with failing ileo-anal pouches there is often diagnostic uncertainty. In this setting, we may offer revisional pouch surgery with biologic "coverage" for presumed Crohn's disease (CD) which enables an alternative to pouch excision and end ileostomy to highly motivated patients. The aim of this study is to assess postoperative outcomes in patients who underwent revisional/redo ileal pouch anal anastomosis (IPAA) for failing pouches with biologic coverage for possible CD. Methods: This is a retrospective cross-sectional study based on data from a tertiary inflammatory bowel disease center. Patients who underwent revisional/redo IPAA surgery between September 2016 and December 2022 were included. The primary outcome measure was the rate of functioning pouch. Results: Of the 213 patients who underwent revisional/redo IPAA surgery, 17 underwent redo IPAA surgery with biologic coverage due to concern for CD. An additional seven patients were started on biologics between the two operative stages of redo IPAA surgery. At a median follow-up of 17 months, the functioning pouch rate was 75%. Conclusions: Revisional IPAA surgery for suspected CD-related complications leading to pouch failure, in conjunction with concurrent medical therapy, provides a stoma-free alternative to patients otherwise facing pouch excision and end ileostomy. Despite the limited number of patients and varying follow-up times, this approach shows promise for maintaining pouch function in a challenging patient population.