Management of IPAA-Associated Persistent Presacral Sinus

Abstract

A persistent presacral sinus tract arising after restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) can cause considerable morbidity and is associated with high rates of pouch failure [1, 2]. These sinuses are blind-ending tracts that form as a result of a non-healing leak or suture/staple line dehiscence at the pouch-anal anastomosis. Although many defects remedy themselves with proper drainage and patience, some chronic tracts may persist and lead to significant compromise in pouch function and longevity [3]. A number of interventions have been performed in patients with IPAA-associated persistent sinus tracts, most of which are in a posterior location, with hopes of achieving either symptom relief or complete closure of the tract. The optimal approach must consider the specific characteristics of the persistent sinus tract, and options range from less invasive endoscopic procedures to more extensive pouch revision and redo of the pouch-anal anastomosis (Table 41.1).