Clinical Application of the Degradable Stent-Secured Intrapouch Bypass in IPAA.

Abstract

Background: IPAA is the standard surgical treatment for ulcerative colitis. However, IPAA has a risk of anastomotic leakage after pouch reconstruction, which may lead to significant morbidity, additional surgeries, and, in many cases, a dysfunctional pouch. This study introduces a technique that enhances the safety of IPAA.

Impact of innovation: We present a novel degradable stent-secured intrapouch bypass designed to minimize the risk of pouch or anastomotic leakage. By preventing direct fecal contact with the anastomosis, this approach aims to improve surgical outcomes and reduce stoma-related morbidity.

Technology, materials, and methods: The degradable stent-secured intrapouch bypass system consists of a biofragmentable stent and a protective sleeve. A total of 18 patients with ulcerative colitis who underwent IPAA with degradable stent-secured intrapouch bypass were identified from a prospectively collected case series conducted over 3 years (2022-2024).

Preliminary results: The mean operative time was 303.9 ± 43.9 minutes, with pouch creation and stent placement taking 21.4 ± 3.2 minutes. No cases of anastomotic leakage or stent-related complications were observed. Seven patients experienced minor complications, all of which resolved with conservative management. The mean time to stent expulsion was 23.9 ± 2.5 days.

Conclusions: The degradable stent-secured intrapouch bypass technique appears to be a promising adjunct for pouch protection in ulcerative colitis surgery, demonstrating both safety and efficacy in this initial series.

Future directions: Future studies should further validate the benefits of this technique in larger clinical trials and investigate long-term patient outcomes.