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Updated: Dec 23, 2025
Author Spotlight: Developing a Rat Model for Pouchitis Research and Treatment
Published on: May 31, 2024
Perianal fistula and the ileoanal pouch - different aetiologies require distinct evaluation
L M Reza1, P F C Lung2,3, A L Lightner4
1Fistula Research Unit, St Mark's Hospital and Academic Institute, London, UK.
Aim:
Restorative proctocolectomy has been widely adopted as the procedure of choice for restoring gastrointestinal continuity following proctocolectomy. It is often associated with improved quality of life and high patient satisfaction; however, the development of a pouch anal fistula can cause significant morbidity. Pouch fistulas are notoriously difficult to treat and there is great heterogeneity in the management reported of these fistulas. A lack of classification, and the assumption that fistulas originating from completely different aetiologies will behave and respond similarly to a particular treatment strategy, precludes meaningful comparison of management outcomes. We aim to introduce consistency in the reporting of pouch fistulas using a novel classification system.
Methods:
A consensus process involving clinicians experienced in the management of pouch fistulas from two high volume tertiary centres was performed.
Results:
We propose that pouch anal fistulas should be classified into four distinct groups according to their aetiology: group 1, anastomotic related; group 2, inflammatory bowel disease related, with sub-classifications Crohn's (type A) and non-Crohn's (type B) in origin; group 3, cryptoglandular related; and group 4, malignancy related.
Conclusion:
Classification of pouch fistulas according to their aetiology will provide consistency in the literature and improve the quality of prospective evidence for the management of pouch fistulas.
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