Perineal Complications after Ileal Pouch-Anal Anastomosis

  • Jeffrey W. Milsom


Despite the fact that the restorative proctocolectomy (RP) has become the therapy of choice in the surgical management of ulcerative colitis, there remains an appreciable complication rate following the operation of up to 50% (1–5). The development of a fistula or abscess in the perineal or vaginal areas following RP heralds a potentially serious problem in the patient, since such an event not only may lead to a significant amount of pain and discharge, but nearly always requires further corrective surgery, and implies some degree of failure of the ileal pouch-anal anastomosis. It also looms as one of the most common reasons for pouch “failure,” meaning that the pouch must be removed because of an inability to surgically correct this problem by other means (1,4).


Anal Canal Internal Opening Ileal Pouch Restorative Proctocolec Advancement Flap 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Galandiuk S, Scott NA, Dozois RR, et al. Ileal pouchanal anastomosis: reoperation for pouch-related complications. Ann Surg 1990;212:446–452.PubMedCrossRefGoogle Scholar
  2. 2.
    Keighley MRB, Grobler S, Bain I. An audit of restorative proctocolectomy. Gut 1993;34:680–684.PubMedCrossRefGoogle Scholar
  3. 3.
    Mikkola K, Luukkonen P, Jarvinen HJ. Long-term results of restorative proctocolectomy for ulcerative colitis. Int J Colorect Dis 1995;10:10–14.CrossRefGoogle Scholar
  4. 4.
    Foley EF, Schoetz DJ, Roberts PL, et al. Rediversion after ileal pouch-anal anastomosis. Dis Colon Rectum 1995; 38:793–798.PubMedCrossRefGoogle Scholar
  5. 5.
    Ozuner G, Hull T, Lee P, et al. What happens to a pelvic pouch when a fistula develops? Dis Colon Rectum 1997;40:543–547.PubMedCrossRefGoogle Scholar
  6. 6.
    Rothenberger DA, Gemlo BT, Deen KI. Complications after ileal pouch-anal anastomosis. In Fazio VW, Allen CD, Keighley MRB, Hanauer S, eds. Inflammatory bowel disease. London: Churchill Livingstone International, 1996;793–801.Google Scholar
  7. 7.
    Wexner AD, Jensen L, Rothenberger DA, et al. Long-term functional analysis of the ileoanal reservoir. Dis Colon Rectum 1989;32:275–281.PubMedCrossRefGoogle Scholar
  8. 8.
    O’Kelly TJ, Merrett M, Mortensen NJ, et al. Pouch vaginal fistula following restorative proctocolectomy. Br J Surg 1994;81:1374–1375.PubMedCrossRefGoogle Scholar
  9. 9.
    Paye F, Penna C, Chiche L, et al. Pouch-related fistula following restorative proctocolectomy. Br J Surg 1996;83:1574–1577.PubMedCrossRefGoogle Scholar
  10. 10.
    Fleshman JW, McLeod RS, Stern H. Improved results following use of an advancement technique in the treatment of ileoanal anastomotic complications. Int J Colorectal Dis 1988;3:161–165.PubMedCrossRefGoogle Scholar
  11. 11.
    Sagar PM. Long-term results of ileal pouch anal anastomosis in patients with Crohn’s disease. Dis Colon Rectum 1996;39:893–898.PubMedCrossRefGoogle Scholar
  12. 12.
    Fazio VW, Tjandra JJ, Lavery IC, et al. Long-term follow-up for strictureplasty in Crohn’s disease. Dis Colon Rectum 1993;36:353.Google Scholar
  13. 13.
    Fazio VW, Tjandra JJ. Pouch advancement and neoileoanal anastomotic suture for anovaginal fistula complicating restorative proctocolectomy. Br J Surg 1992;79:694–696.PubMedCrossRefGoogle Scholar
  14. 14.
    Lee PY, Fazio VW. Pouch-vaginal fistula following restorative proctocolectomy: characteristics and outcome. Dis Colon Rectum 1995;38:P13.Google Scholar
  15. 15.
    Wu J. Strictureplasty in Crohn’s disease. In Cameron JL, ed. Current surgery therapy. Philadelphia, BC Decker, 1997; in pressGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1999

Authors and Affiliations

  • Jeffrey W. Milsom

There are no affiliations available

Personalised recommendations