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Pouch-Vaginal Fistula After Ileal Pouch-Anal Anastomosis: Treatment and Outcomes

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

PURPOSE

Pouch-vaginal fistula is an uncommon but serious complication after ileal pouch anal anastomosis. The management of pouch-vaginal fistulas is challenging and a number of treatment options exist. The purpose of this study was to examine the outcomes after various procedures for pouch-vaginal fistula performed at our institution.

METHODS

Patients who were treated for pouch-vaginal fistula at Mount Sinai Hospital were identified from a prospectively maintained database. Demographic, disease history, treatment, and outcomes data were obtained. Treatment success was defined as no recurrence of the fistula with a functioning pouch and no ileostomy.

RESULTS

Since November 1982, 24 of 619 (3.9 percent) women who had primary ileal pouch-anal anastomosis performed at Mount Sinai Hospital developed a pouch-vaginal fistula. Five women had ileal pouch-anal anastomosis performed at another institution and were referred for management of their pouch-vaginal fistula. Local and/or combined abdominoperineal repairs were performed in 22 of 29 patients. Combined abdominoperineal repairs were associated with a higher success rate than that of local perineal repairs (52.9 vs. 7.9 percent, respectively, at 10 years after repair; p = 0.035). Overall, 50 percent (11/22) of patients who underwent surgical repair of a pouch-vaginal fistula had a successful result with a functioning pouch and no recurrence of the fistula, and 21 percent (6/29) of patients required pouch excision.

CONCLUSIONS

The management of pouch-vaginal fistula after ileal pouch-anal anastomosis is associated with a high recurrence rate. Combined abdominoperineal repair appears to offer better results than those of local procedures.

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Authors and Affiliations

  1. IBD Research Unit, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Canada

    Paul M. Johnson M.D., Brenda I. O’Connor R.N., Zane Cohen M.D. & Robin S. McLeod M.D.

  2. Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Canada

    Paul M. Johnson M.D., Zane Cohen M.D. & Robin S. McLeod M.D.

  3. Samuel Lunenfeld Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Canada

    Robin S. McLeod M.D.

  4. Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

    Robin S. McLeod M.D.

Authors
  1. Paul M. Johnson M.D.
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  2. Brenda I. O’Connor R.N.
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  3. Zane Cohen M.D.
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  4. Robin S. McLeod M.D.
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Johnson, P., O’Connor, B., Cohen, Z. et al. Pouch-Vaginal Fistula After Ileal Pouch-Anal Anastomosis: Treatment and Outcomes. Dis Colon Rectum 48, 1249–1253 (2005). https://doi.org/10.1007/s10350-004-0872-9

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  • DOI: https://doi.org/10.1007/s10350-004-0872-9

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