Risk factors associated with ileal pouch-related fistula following restorative proctocolectomy

• Published in: British journal of surgery Vol. 92; no. 10; pp. 1270 - 1276
• Main Authors: Tekkis, P. P, Fazio, V. W., Remzi, F., Heriot, A. G., Manilich, E., Strong, S. A.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01-10-2005; Wiley
• Subjects: Abdominal Wall; Biological and medical sciences; Colitis, Ulcerative - complications; Colitis, Ulcerative - surgery; Colonic Pouches - adverse effects; Crohn Disease - complications; Crohn Disease - surgery; Disease-Free Survival; Female; Fistula - etiology; Follow-Up Studies; General aspects; Humans; Intestinal Fistula - etiology; Length of Stay; Male; Medical sciences; Perineum; Proctocolectomy, Restorative - adverse effects; Risk Factors; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Vaginal Fistula - etiology; Medicine; Treatment; Surgery; Risk factor; Ileal pouch; Fistula; Epidemiology; Ileal pouch-anal anastomosis
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.5071

Introduction:
Pouch‐related fistula occurs in 5–10 per cent of patients after restorative proctocolectomy. The present study identified risk factors associated with the development of such fistulas.
Methods:
Data on preoperative and postoperative risk factors were recorded from 1965 patients who underwent restorative proctocolectomy in a single tertiary centre between 1983 and 2001. Cox regression analysis was used to identify independent predictors of pouch–perineal, pouch–abdominal wall and pouch–vaginal fistula during follow‐up.
Results:
Median patient follow‐up was 4·1 (range 0–19) years. By 15 years' follow‐up, pouch–vaginal fistulas had occurred in 44 women (5·2 per cent). The prevalence of ileal pouch–perineal and pouch–abdominal wall fistula was 3·6 per cent (70 patients) and 1·5 per cent (30 patients) respectively. Independent predictors of pouch‐related fistula identified by multivariate analysis were diagnosis of indeterminate colitis or Crohn's disease (hazard ratio (HR) 1·28 (95 per cent confidence interval (c.i.) 1·00 to 1·65) and 1·73 (95 per cent c.i. 1·07 to 3·48) respectively versus ulcerative colitis or familial adenomatous polyposis), previous anal pathology (HR 3·43 (95 per cent c.i. 2·43 to 4·84) and 4·02 (95 per cent c.i. 1·27 to 12·77) respectively for perineal abscess and fistula in ano versus no previous anal pathology), abnormal anal manometry (HR 4·29 (95 per cent c.i. 2·33 to 7·91)), patient sex (HR 0·74 (95 per cent c.i. 0·58 to 0·95) for men versus women) and pelvic sepsis (HR 3·79 (95 per cent c.i. 2·48 to 5·79)).
Conclusion:
This study suggests that Crohn's disease and the clinical signs that favour the diagnosis of Crohn's disease may contribute to the development of pouch‐related fistula. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Crohn's disease most common cause of late fistula