Can the pouch be saved?

From 1980 to 1986, 165 patients underwent ileal reservoir procedures at the Lahey Clinic Medical Center; 142 (86 percent) had J-shaped pouches constructed, and 23 (14 percent) had S-shaped pouches constructed. In this series, 42 complications specifically related to the pouch occurred in 36 patients. Stricture was most common, followed by separation of the ileoanal anastomosis, pelvic sepsis, complex fistula, and a leaking pouch. Through judicious application of remedial operations and either delay in closure of the ileostomy or establishment of proximal loop ileostomy, only seven patients required reestablishment of fecal diversion. The authors urge aggressive diagnostic and therapeutic efforts to save the pouch and maintain satisfactory function in most patients.