Abstract
PURPOSE: The purpose of the study was to evaluate the outcome of surgical management of pouch-vaginal fistulas in females who had undergone restorative proctocolectomy. METHODS: This study was designed as a retrospective chart review of females treated for pouch-vaginal fistulas from 1983 to 2000. All patients were followed up using our prospective pouch registry, with additional data collected by interview or mailed questionnaire. RESULTS: Sixty females were identified (mean age, 33.3 ± 1.3 years), of whom 33 had their initial restorative proctocolectomy done at our institution. Preoperative diagnosis was ulcerative colitis (88 percent), indeterminate colitis (10 percent), and familial adenomatous polyposis (2 percent). Average time to pouch-vaginal fistula following restorative proctocolectomy was 21 months (range, 1–132 months). Postoperative pelvic sepsis had occurred in 17 (28 percent) patients. Primary treatment modalities included the following: local repairs (n = 46, 77 percent), the majority of which were ileal advancement flaps; redo restorative proctocolectomy (n = 6, 10 percent); and pouch excision (n = 5, 8 percent). Initial healing was achieved in 20 patients. An additional 11 patients with recurrences healed after repeat procedures. The overall healing rate was 52 percent at 49.4 ± 3.8 months follow-up. Pouch failure was the eventual outcome in 13 (22 percent) patients and 16 (27 percent) patients had persistent pouch-vaginal fistula. A delayed diagnosis of Crohn’s disease was made in 24 patients. Crohn’s disease patients had lower success rates following ileal advancement flaps compared with the non-Crohn’s group (25 vs. 48 percent, respectively), much lower overall healing rates of their pouch-vaginal fistulas (17 vs. 75 percent, respectively), and a higher incidence of pouch failure (33 vs. 14 percent, respectively). CONCLUSION: Pouch-vaginal fistulas are a difficult problem in females following restorative proctocolectomy. However, local repair can be successful with good functional outcomes. Redo restorative proctocolectomy may also achieve healing if local repairs are not possible or have failed. A delayed diagnosis of Crohn’s disease results in worse treatment outcome and higher pouch failure rates.
Similar content being viewed by others
References
JH Pemberton SF Phillips RR Ready AR Zinsmeister OH Beahrs (1989) ArticleTitleQuality of life after Brooke ileostomy and ileal pouch-anal anastomosis. Comparison of performance status Ann Surg 209 620–628
VW Fazio Y Ziv JM Church et al. (1995) ArticleTitleIleal pouch-anal anastomoses Ann Surg 222 120–127
P Setti-Carraro JK Ritchie KH Wilkinson RJ Nicholls PR Hawley (1994) ArticleTitleThe first 10 years’ experience of restorative proctocolectomy for ulcerative colitis Gut 35 1070–1075
P Belliveau J Trudel CA Vasilevsky B Stein PH Gordon (1999) ArticleTitleIleoanal anastomosis with reservoirs Can J Surg 42 345–352
HM MacRae RS McLeod Z Cohen BI O’Connor EN Ton (1997) ArticleTitleRisk factors for pelvic pouch failure Dis Colon Rectum 40 257–262
G Ozuner T Hull P Lee VW Fazio (1997) ArticleTitleWhat happens to a pelvic pouch when a fistula develops? Dis Colon Rectum 40 543–547
F Paye C Penna L Chiche E Tiret P Frileux R Parc (1996) ArticleTitlePouch-related fistula following restorative proctocolectomy Br J Surg 83 1574–1577
TJ O’Kelly M Merett NJ Mortensen TC Dehn M Kettlewell (1994) ArticleTitlePouch-vaginal fistula after restorative proctocolectomy Br J Surg 81 1374–1375
MR Keighley SP Grobler (1993) ArticleTitleFistula complicating restorative proctocolectomy Br J Surg 80 1065–1067
JS Groom RJ Nicholls PR Hawley RK Phillips (1993) ArticleTitlePouch-vaginal fistula following restorative proctocolectomy Br J Surg 80 936–940
PY Lee VW Fazio JM Church TL Hull KW Eu IC Lavery (1997) ArticleTitleVaginal fistula following restorative proctocolectomy Dis Colon Rectum 80 752–759
SD Wexner DA Rothenberger L Jensen et al. (1989) ArticleTitleIleal pouch vaginal fistulas Dis Colon Rectum 32 460–465
VW Fazio JJ Tjandra (1992) ArticleTitlePouch advancement and neoileoanal anastomosis for anastomotic stricture and anovaginal fistula complicating restorative proctocolectomy Br J Surg 79 696–697
AA Deutsch RS Mcleod J Cullen Z Cohen (1991) ArticleTitleResults of the pelvic-pouch procedure in patients with Crohn’s disease Dis Colon Rectum 34 475–477
IE Gecim BG Wolff JH Pemberton RM Devine RR Dozois (2000) ArticleTitleDoes technique of anastomosis play any role in developing late perianal abscess or fistula? Dis Colon Rectum 43 1241–1245
OA Ogunbiyi S Korsgen MR Keighley (1997) ArticleTitlePouch salvage Dis Colon Rectum 40 548–552
T Sonoda VW Fazio (2000) ArticleTitleControversies in the construction of the ileal pouch anal anastomosis Semin Gastrointest Dis 11 33–40
EM Breen DJ Schoetz SuffixJr PW Marcello et al. (1998) ArticleTitleFunctional results after perineal complications of ileal pouch-anal anastomosis Dis Colon Rectum 41 691–695
D Burke CJ van Laarhoven F Herbst RJ Nicholls (2001) ArticleTitleTransvaginal repair of pouch-vaginal fistula Br J Surg 88 241–245
Z Cohen D Smith R McLeod (1998) ArticleTitleReconstructive surgery for pelvic pouches World J Surg 22 342–346
Y Panis B Poupard J Nemeth A Lavergne P Hautefeuille P Valleur (1996) ArticleTitleIleal pouch/anal anastomosis for Crohn’s disease Lancet 347 854–857
NM Hyman VW Fazio WB Tuckson IC Lavery (1991) ArticleTitleConsequences of ileal pouch-anal anastomosis for Crohn’s colitis Dis Colon Rectum 34 653–657
H Kotangi K Kramer VW Fazio RE Petras (1991) ArticleTitleDo microscopic abnormalities at resection margins correlate with increased anastomotic recurrence in Crohn’s disease? Retrospective analysis of 100 cases Dis Colon Rectum 34 909–916
PM Sagar RR Dozios BG Wolff (1996) ArticleTitleLong-term results of ileal pouch-anal anastomosis in patients with Crohn’s disease Dis Colon Rectum 39 893–898
DH Present P Rutgeerts S Targan et al. (1999) ArticleTitleInfliximab for the treatment of fistulas in patients with Crohn’s disease N Engl J Med 340 1398–1405
R Lofberg (1999) ArticleTitleTreatment of fistulas in Crohn’s disease with infliximab Gut 45 642–643
E Ricart R Panaccione EV Loftus WJ Tremaine WJ Sandborn (1999) ArticleTitleSuccessful management of Crohn’s disease of the ileoanal pouch with infliximab Gastroenterology 117 429–432
CS Yu JH Pemberton D Larson (2000) ArticleTitleIleal pouch-anal anastomosis in patients with indeterminate colitis Dis Colon Rectum 43 1487–1496
Author information
Authors and Affiliations
About this article
Cite this article
Shah, N.S., Remzi, F., Massmann, A. et al. Management and Treatment Outcome of Pouch-Vaginal Fistulas Following Restorative Proctocolectomy. Dis Colon Rectum 46, 911–917 (2003). https://doi.org/10.1007/s10350-004-6684-0
Issue Date:
DOI: https://doi.org/10.1007/s10350-004-6684-0