Abstract
Abstract
Aim
Conversion of a failed ileoanal J‐pouch to a continent ileostomy (K‐pouch) is an uncommon salvage option that may preserve continence and small‐bowel length. Outcomes after J‐to‐K pouch conversion compared with primary K‐pouch creation remain poorly defined. This IDEAL stage 3 study compared short‐ and long‐term outcomes between these two approaches.
Method
We performed a retrospective review of patients undergoing primary K‐pouch creation or J‐to‐K pouch conversion at a tertiary referral centre between 2013 and 2025. Demographic, clinical and operative characteristics, 30‐day postoperative outcomes and long‐term pouch‐related outcomes were evaluated. Primary outcomes were pouch revision and pouch excision. Secondary outcomes included 30‐day morbidity and other long‐term complications.
Results
Forty‐four patients were included, of whom 28 underwent primary K‐pouch creation and 16 underwent J‐to‐K pouch conversion. Median age, body mass index, operation duration and blood loss were comparable between groups. Thirty‐day outcomes, including readmission, reoperation, ileus, abscess and transfusion, did not differ significantly. After a median follow‐up of 43 vs. 42 months, pouch survival remained high in both groups (82.1% vs. 93.8%,
p
= 0.39). Kaplan–Meier analysis demonstrated similar revision‐free (
p
= 0.39) and excision‐free (
p
= 0.36) survival. On multivariable analysis, 30‐day transfusion was the only independent predictor of pouch failure (odds ratio [OR] 7.56, 95% confidence interval [CI] 1.02–56.25;
p
= 0.048).
Conclusion
J‐to‐K pouch conversion achieved high pouch survival and 30‐day morbidity comparable to primary K‐pouch creation, supporting its role as an effective salvage option in selected patients with J‐pouch failure.