A Novel Approach to Ileal Pouch Prolapse Repair Using Fibrin Sealant

Abstract

Purpose/Background: The ileal pouch anal anastomosis is a commonly accepted neorectum after total proctocolectomy for familial adenomatous polyposis and ulcerative colitis. Generally patients have decent bowel control, but ileal pouches are not without complications. One relatively uncommon complication is ileal pouch prolapse. Prolapse can be either mucosal or full thickness, similar to rectal prolapse. There is limited literature detailing the frequency and management of ileal pouch prolapse. The methods described are generally suture repairs with or without mesh. Fibrin glue has been described for sutureless mesh fixation in total extraperitoneal hernia repairs with good results. Similar sutureless approaches have been applied to laparoscopic rectopexy. To date, there are no reports of this technique being used in ileal pouch prolapse. Using the theory behind fibrin use in hernia repairs, here we describe a fibrin glue ileal pouch pexy to treat prolapse after total proctocolectomy with ileal pouch anal anastomosis. Methods/Interventions: Our patient is a 56-year-old woman who underwent a total proctocolectomy with ileal J pouch secondary to ulcerative colitis 11 years prior who presented with pouch prolapse, originally treated as pouchitis. Initial treatment failure prompted urgent operative reduction without surgical repair. Symptoms persisted and she was taken for definitive repair. Due to concern of pouch fragility, suture repair was not attempted. Instead, the pouch was mobilized within the pelvis and fibrin sealant was applied to the pouch and sacrum. Results/Outcome(s): The patient tolerated the procedure well. She was discharged on post op day five. In the five months since repair, she has had nighttime incontinence but no evidence of recurrent prolapse. Conclusions/Discussion: IPP is an uncommon complication after total proctocolectomy with ileal pouch. Fibrin glue is an alternative to mesh or suture pexy to repair IPP. There has been no recurrence in five-month follow up. The longterm durability of such a repair is yet to be determined.