The IPAA (ileal pouch-anal anastomosis, J-pouch procedure) is performed for ulcerative colitis. Which postoperative complication is MOST commonly responsible for pouch failure requiring pouch excision in the long term?
- A Septic complications (pelvic sepsis and pouch fistula) ✓
- B Pouchitis
- C Crohn's disease of the pouch (Crohn's-like inflammation)
- D Anastomotic stricture
Explanation
Septic complications — specifically pelvic sepsis (anastomotic leak, pelvic abscess) and resulting pouch fistulae (pouch-vaginal, pouch-perineal) — are the leading cause of pouch failure requiring excision in long-term follow-up. While pouchitis is the most COMMON complication after IPAA (occurring in up to 50% of patients at some point), it is usually treated successfully with antibiotics (metronidazole, ciprofloxacin) or VSL#3 probiotic and rarely causes pouch excision. Crohn's diagnosis of the pouch and septic complications account for the majority of pouch excisions in series with long follow-up.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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