Quality of life before and after redo IPAA: does pouch salvage improve quality of life?

BACKGROUND: Quality of life (QoL) and functional outcomes after redo ileoanal pouch (IPAA) surgery are worse than after primary (index) pouch surgery. However, QoL in failing pouches compared to after redo IPAA has not been reported. We hypothesized that QoL after redo IPAA would be improved compared with failing IPAAs immediately prior to redo surgery. METHODS: Adults who underwent redo IPAA (1984-2024), had successful loop ileostomy closure, and at least one pouch survey were included. Our primary outcome was the Cleveland Global Quality of Life Index (CGQLI; range, 0 [lowest] to 1 [highest]). Survey responses before and after redo IPAA were compared using unmatched and matched pair analyses. RESULTS: A total of 528 redo pouches were included: pouch excision with neo-IPAA in 318 (60%) and pouch repair with neo-IPAA in 210 (40%); 298 (56%) had follow-up survey data available. After redo IPAA, social, work, and sexual restrictions all decreased (p ≤ 0.05), and bowel movements decreased from 10 to 8 per 24 h (p = 0.05), whereas urgency, incontinence, seepage, pad usage, fiber, antidiarrheal usage, and dietary restrictions were comparable to before redo IPAA. After redo IPAA, quality of health, quality of energy, QoL, and CGQLI were significantly higher than those before redo IPAA (p < 0.0001). When surveyed after redo IPAA, 86% of patients would undergo redo surgery again, 88% would recommend redo IPAA, and happiness with surgery increased (p = 0.001). CONCLUSION: Redo IPAA improved quality of life and restrictions observed prior to redo pouch surgery without compromising functional outcomes for most patients.