Invited comment on Selvaggi et al.: Is omitting pouchography before ileostomy takedown safe after negative clinical examination in asymptomatic patients with pelvic ileal pouch? An observational study

Excerpt

In the manuscript “Is omitting pouchography before ileostomy takedown safe after negative clinical examination in asymptomatic patients with pelvic ileal pouch? An observational study,” Selvaggi et al. [1] have questioned the utility of routine pouchography prior to the restoration of intestinal continuity following ileal pouch-anal anastomosis (IPAA). In their study, they identified 186 patients over a 23-year period who had undergone an IPAA with diverting ileostomy performed by a single surgeon. All patients underwent regular clinical examinations and endoscopic evaluation prior to takedown of their ileostomy and were found to have normal endoscopic examinations. Fifty-four of these patients underwent pouchography before takedown of their ileostomy, while 132 patients did not. In the pouchography group, 5 patients had abnormal findings (anastomotic sinuses) and underwent ileostomy closure without delay. In the follow-up period (12 months minimum), 2 patients presented with pouch-related fistulas: one from the pouchography group (who had a normal preoperative pouchography) and one from the clinical examination group (who had a normal preoperative clinical and endoscopic examination). Because the pouchographies performed on asymptomatic patients did not change management, the authors conclude that pouchography may be safely omitted before ileostomy takedown if there is no clinical and endoscopic evidence of pelvic sepsis or ileo–anal anastomotic complications. …