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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.
Diseases of the Colon and Rectum
|May 1, 1997
Summary
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.