The usefulness of the H‐pouch configuration in salvage surgery for failed ileal pouches

Aim Abdominal salvage surgery for a failed ileal pouch–anal anastomosis (5) is safe and feasible in experienced hands. When salvaging an ileal pouch or creating a new J, S or W pouch may not be feasible, construction of an H‐pouch may be the final option. This study reports a single colorectal surgeon's experience on H‐pouch anal anastomosis in patients referred with a failed ileal pouch. Method Patients undergoing transabdominal salvage surgery with H‐pouch formation for a failed pouch from February 2012 to May 2016 were evaluated. Results Five patients were identified with a mean age of 46 (22–63) years. The pathological diagnosis was mucosal ulcerative colitis in all patients. Three patients had an initial traditional two‐stage J‐pouch creation and two patients had an initial three‐stage approach. The median time to redo pouch surgery after the index IPAA creation was 99 (11–158) months. One patient required excision of the pouch and two patients had a complication within 30 days of surgery. Conclusion The H‐pouch is a good alternative for a failed IPAA when another type of reservoir is not an option.