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What happens to a pelvic pouch when a fistula develops?
1Department of Colon and Rectal Surgery, Cleveland Clinic Foundation, Ohio, USA.
Insights
More than 60% of patients can achieve successful fistula treatment after pelvic pouch surgery, though multiple procedures may be necessary. Ultimately, 32% of pouches were removed.
Area of Science:
- Gastroenterology
- Surgical Oncology
Background:
- Pelvic pouch surgery is a common treatment for ulcerative colitis and familial polyposis.
- Fistulas are a known complication of pelvic pouch surgery, potentially impacting patient outcomes.
Purpose of the Study:
- To determine the outcomes of pelvic pouches in patients who develop fistulas following surgery.
- To analyze factors influencing fistula treatment success and pouch survival.
Main Methods:
- A retrospective review of 1,040 pelvic pouch surgeries performed between 1983 and 1995.
- Analysis of data from chart reviews and a pouch registry for patients with pouch-related fistulas.
- Evaluation of 59 patients with various fistula types and diagnoses.
Main Results:
- Among 59 patients with fistulas, 111 treatment surgeries were performed.
- At a mean follow-up of 26 months, 34 patients had functioning pouches without fistulas.
- 19 pouches (32%) were excised, while 5 patients had closed fistulas but refused ileostomy closure.
Conclusions:
- Successful fistula treatment is achievable in over 60% of patients with pelvic pouches.
- Multiple surgical procedures may be required for successful fistula resolution.
- Pouch excision occurred in 32% of cases, indicating a significant rate of pouch loss despite treatment efforts.
Purpose:
The aim of this article is to determine the outcome of the pelvic pouch after the occurrence of a fistula.
Materials And Methods:
From 1983 to 1995, 1,040 pelvic pouch surgeries were done at our institution. We reviewed the records of all patients with pouch-related fistulas. Data were collected from chart reviews and our pouch registry.
Results:
Among 59 patients (22 males) with fistulas, mean age was 33 (range, 19-57) years. Preoperative diagnosis was mucosal ulcerative colitis (n = 52), indeterminate colitis (n = 6), and familial polyposis (n = 1). Site of fistulas included pouch/vaginal (n = 24), pouch/ cutaneous (n = 11), pouch/perineal (n = 16), and pouch/ presacral (n = 8). Postoperative diagnosis was mucosal ulcerative colitis (n = 40), Crohn's disease (n = 14), indeterminate colitis (n = 4), and familial polyposis (n = 1). One hundred eleven (range, 1-7) surgeries for treatment were performed. At a mean follow-up of 26 (range, 1-121) months, 19 pouches (32 percent) had been excised, 34 patients had functioning pouches and no fistula, 5 patients had a closed fistula but refused ileostomy closure, and 1-patient had died of unrelated causes (but the fistula was closed). Pouch type and preoperative diagnosis did not statistically affect pouch failure rates (P = 0.43 and 0.10. respectively).
Conclusion:
Successful treatment of fistula from a pelvic pouch can be achieved in more than 60 percent of patients. However, multiple procedures may be needed for a successful outcome. Ultimately, 32 percent had their pouches excised.