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Does technique of anastomosis play any role in developing late perianal abscess or fistula?

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Diseases of the Colon & Rectum

Abstract

PURPOSE: This study examines the risk factors for developing perianal abscess or fistula formation after ileal pouch-anal anastomosis procedure for chronic ulcerative colitis or familial adenomatous polyposis. METHODS: A total of 1,457 patients with J-pouch, 1,304 (89.5 percent) with chronic ulcerative colitis and 153 (10.5 percent) with familial adenomatous polyposis who had a two-stage procedure without any evidence of previous perianal disease were included in the study. The effect of pouch-to-anal anastomosis type on perianal abscess or fistula formation was evaluated. RESULTS: A total of 108 patients (7.4 percent) had a perianal abscess or fistula after the ileal pouch-anal anastomosis procedure after at least one year of follow-up. No statistically significant difference was identified in fistula formation regarding the age and gender of the patients (P>0.05), nor did the risk of fistula formation differ significantly between the patients with handsewnvs. stapled anastomoses (P>0.05). However, patients with a diagnosis of chronic ulcerative colitis, compared with patients with familial adenomatous polyposis, had a statistically higher risk of developing abscess or fistula (P=0.012). CONCLUSION: The most important risk factor in developing perianal sepsis in long-term patients with ileal pouch-anal anastomosis is the initial disease type. After excluding patients without Crohn's disease, the risk of developing an abscess or fistula was found to be significantly greater in patients with chronic ulcerative colitis compared with patients with familial adenomatous polyposis, and this risk is independent of anastomotic technique.

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References

  1. Hultén L. Problems after ileo-pouch anal anastomosis for ulcerative colitis. How can we prevent it? What can we do? Neth J Med 1994;45:80–5.

    Google Scholar 

  2. Paye F, Penna C, Chiche L, Tiret E, Frileux P, Parc R. Pouch-related fistula following restorative proctectomy. Br J Surg 1996;83:1574–7.

    Google Scholar 

  3. Panis Y, Poupard B, Nemeth J, Lavergne A, Hautefeuille P, Valleur P. Ileal pouch/anal anastomosis for Crohn's disease. Lancet 1996;347:854–7.

    Google Scholar 

  4. Galandiuk S, Scott NA, Dozois RR,et al. Ileal pouchanal anastomosis. Ann Surg 1990;212:446–54.

    Google Scholar 

  5. Seow-Choen A, Tsunoda A, Nicholls RJ. Prospective randomized trial comparing anal function after handsewn ileoanal anastomosis with mucosectomy versus stapled ileoanal anastomosis without mucosectomy in restorative proctocolectomy. Br J Surg 1991;78:430–4.

    Google Scholar 

  6. Sugarman HJ, Newsome HH, Decosta G, Zfass AM. Stapled ileoanal anastomosis for ulcerative colitis and familial polyposis without a temporary diverting ileostomy. Ann Surg 1991;213:606–19.

    Google Scholar 

  7. McIntyre PB, Pemberton JH, Beart RW Jr, Devine RM, Nivatvongs S. Double-stapledvs. handsewn ileal pouch-anal anastomosis in patients with chronic ulcerative colitis. Dis Col Rectum 1994;37:430–3.

    Google Scholar 

  8. Luukkonen P, Jarvinen H. Stapled vs hand-sutured ileoanal anastomosis in restorative proctocolectomy. Arch Surg 1993;128:437–40.

    Google Scholar 

  9. Keighley MR, Grobler SP. Fistula complicating restorative proctocolectomy. Br J Surg 1993;80:1065–7.

    Google Scholar 

  10. Dozois RR. Pelvic and perianastomotic complications after ileonanal anastomosis. Perspect Colon Rectal Surg 1988;1:113–21.

    Google Scholar 

  11. Pemberton JH, Kelly KA, Beart RW Jr, Dozois RR, Wolff BG, Ilstrup DM. Ileal pouch-anal anastomosis for chronic ulcerative colitis: long-term results. Ann Surg 1987;206:504–13.

    Google Scholar 

  12. Fazio VW, Tjandra JJ. Transanal mucosectomy: ileal pouch advancement for anorectal dysplasia or inflammation after restorative proctocolectomy. Dis Colon Rectum 1994;37:1008–11.

    Google Scholar 

  13. O'Connell PR, Pemberton JH, Weiland LH,et al. Does rectal mucosa regenerate after ileoanal anastomosis? Dis Colon Rectum 1987;30:1–5.

    Google Scholar 

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Authors and Affiliations

  1. From the Division of Colon and Rectal Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota

    I. E. Gecim M.D.,  B. G. Wolff M.D., J. H. Pemberton M.D., R. M. Devine M.D. & R. R. Dozois M.D.

Authors
  1. I. E. Gecim M.D.
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  2. B. G. Wolff M.D.
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  3. J. H. Pemberton M.D.
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  4. R. M. Devine M.D.
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  5. R. R. Dozois M.D.
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Gecim, I.E., Wolff, B.G., Pemberton, J.H. et al. Does technique of anastomosis play any role in developing late perianal abscess or fistula?. Dis Colon Rectum 43, 1241–1245 (2000). https://doi.org/10.1007/BF02237428

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  • DOI: https://doi.org/10.1007/BF02237428

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