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Pouch-vaginal fistula

J S Groom1, R J Nicholls, P R Hawley

  • 1Department of Surgery, St Mark's Hospital, London, UK.

The British Journal of Surgery
|July 1, 1993
PubMed
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Pouch-vaginal fistulas occurred in 10.6% of women after restorative proctocolectomy. The prognosis is worse for fistulas developing after ileostomy closure, and optimal management remains unclear.

Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Surgical Complications

Background:

  • Restorative proctocolectomy is a surgical procedure for ulcerative colitis and familial adenomatous polyposis.
  • Pouch-vaginal fistula is a known complication following this surgery.
  • Understanding risk factors and outcomes is crucial for patient management.

Purpose of the Study:

  • To determine the incidence of pouch-vaginal fistula after restorative proctocolectomy.
  • To analyze factors associated with fistula development.
  • To evaluate treatment outcomes and prognosis based on fistula timing.

Main Methods:

  • Retrospective review of 161 women undergoing restorative proctocolectomy between January 1976 and June 1991.
  • Analysis of fistula incidence, timing (pre- vs. post-ileostomy closure), and associated factors.

Related Experiment Videos

  • Evaluation of treatment strategies and outcomes, including healing rates and need for pouch excision.

    • Main Results:

    • Seventeen women (10.6%) developed pouch-vaginal fistula.
    • Fistula incidence was similar in inflammatory and non-inflammatory bowel disease.
    • Stapled ileoanal anastomosis showed a higher fistula rate (17%) than hand-sewn (8.3%).
    • Prognosis was poorer for fistulas occurring after ileostomy closure (3/17 healed) compared to before closure (3/5 healed).
    • Eight patients required pouch excision.

    Conclusions:

    • Pouch-vaginal fistula is a significant complication of restorative proctocolectomy.
    • Fistulas developing after ileostomy closure have a worse prognosis.
    • Optimal management strategies for pouch-vaginal fistula require further investigation.