Clinical Application of the Degradable Stent-Secured Intra-Pouch Bypass in Ileal Pouch-anal Anastomosis.

Abstract

Background: Ileal pouch-anal anastomosis is the standard surgical treatment for ulcerative colitis. However, ileal pouch-anal anastomosis carries a risk of anastomotic leakage following pouch reconstruction, which may lead to significant morbidity, additional surgeries, and, in many cases, a dysfunctional pouch. This study aims to introduce a technique that enhances the safety of ileal pouch-anal anastomosis.

Impact of innovation: We present a novel degradable stent-secured intra-pouch 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 intra-pouch bypass system consists of a biofragmentable stent and a protective sleeve. A total of 18 ulcerative colitis patients who underwent ileal pouch-anal anastomosis with degradable stent-secured intra-pouch bypass were identified from a prospectively collected case series conducted over three years (2022-2024).

Results: The average 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 and future directions: The degradable stent-secured intra-pouch 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 studies should further validate the benefits of this technique in larger clinical trials and investigate long-term patient outcomes.