Surgical Management of Pouch-Vaginal Fistula after Restorative Proctocolectomy

Shingo Tsujinaka, Dan Ruiz, Steven D. Wexner, Mirza K. Baig, Dana R. Sands, Eric G. Weiss, Juan J. Nogueras, Jonathan Efron, Anthony M. Vernava

Research output: Contribution to journalArticle

Abstract

Background: Pouch-vaginal fistula (PVF) is a devastating complication after restorative proctocolectomy with ileal pouch anal anastomosis (IPAA). The aim of this study was to evaluate the surgical management of PVF. Methods: After Institutional Review Board approval, all patients treated for PVF between 1988 and 2003 were retrospectively reviewed. Success of treatment was defined as the complete absence of symptoms or no radiologic evidence of fistula. Results: The study included 23 female patients; indications for IPAA were mucosal ulcerative colitis in 20 (87%), indeterminate colitis in 1 (4.3%), and familial adenomatous polyposis in 2 (8.7%) patients. Seven patients with mucosal ulcerative colitis were postoperatively diagnosed with Crohn's disease. Mean time interval from initial IPAA to development of symptomatic fistula was 17.2 months. Mean number of surgical treatments was 2.2. Overall, success was achieved in 17 (73.9%) patients at a mean followup of 52.3 months. Fistulas in patients with Crohn's disease occurred relatively late after IPAA (p = 0.015) and required a median of three (p = 0.001) surgical procedures, compared with patients without Crohn's disease. Pelvic sepsis after original IPAA occurred in eight (35.8%) patients, four (50%) of whom ultimately required pouch excision. Conclusions: Fecal diversion and local procedures are effective in the majority of patients with PVF after IPAA. Patients with Crohn's disease tend to have a delayed onset of fistula occurrence and require more extensive surgical management. Pelvic sepsis can be a predictive factor of poor outcomes.

Original languageEnglish (US)
Pages (from-to)912-918
Number of pages7
JournalJournal of the American College of Surgeons
Volume202
Issue number6
DOIs
StatePublished - Jun 2006
Externally publishedYes

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Vaginal Fistula
Restorative Proctocolectomy
Colonic Pouches
Crohn Disease
Fistula
Ulcerative Colitis
Sepsis
Adenomatous Polyposis Coli
Research Ethics Committees
Colitis

ASJC Scopus subject areas

  • Surgery

Cite this

Tsujinaka, S., Ruiz, D., Wexner, S. D., Baig, M. K., Sands, D. R., Weiss, E. G., ... Vernava, A. M. (2006). Surgical Management of Pouch-Vaginal Fistula after Restorative Proctocolectomy. Journal of the American College of Surgeons, 202(6), 912-918. https://doi.org/10.1016/j.jamcollsurg.2006.02.014

Surgical Management of Pouch-Vaginal Fistula after Restorative Proctocolectomy. / Tsujinaka, Shingo; Ruiz, Dan; Wexner, Steven D.; Baig, Mirza K.; Sands, Dana R.; Weiss, Eric G.; Nogueras, Juan J.; Efron, Jonathan; Vernava, Anthony M.

In: Journal of the American College of Surgeons, Vol. 202, No. 6, 06.2006, p. 912-918.

Research output: Contribution to journalArticle

Tsujinaka, S, Ruiz, D, Wexner, SD, Baig, MK, Sands, DR, Weiss, EG, Nogueras, JJ, Efron, J & Vernava, AM 2006, 'Surgical Management of Pouch-Vaginal Fistula after Restorative Proctocolectomy', Journal of the American College of Surgeons, vol. 202, no. 6, pp. 912-918. https://doi.org/10.1016/j.jamcollsurg.2006.02.014
Tsujinaka, Shingo ; Ruiz, Dan ; Wexner, Steven D. ; Baig, Mirza K. ; Sands, Dana R. ; Weiss, Eric G. ; Nogueras, Juan J. ; Efron, Jonathan ; Vernava, Anthony M. / Surgical Management of Pouch-Vaginal Fistula after Restorative Proctocolectomy. In: Journal of the American College of Surgeons. 2006 ; Vol. 202, No. 6. pp. 912-918.
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abstract = "Background: Pouch-vaginal fistula (PVF) is a devastating complication after restorative proctocolectomy with ileal pouch anal anastomosis (IPAA). The aim of this study was to evaluate the surgical management of PVF. Methods: After Institutional Review Board approval, all patients treated for PVF between 1988 and 2003 were retrospectively reviewed. Success of treatment was defined as the complete absence of symptoms or no radiologic evidence of fistula. Results: The study included 23 female patients; indications for IPAA were mucosal ulcerative colitis in 20 (87{\%}), indeterminate colitis in 1 (4.3{\%}), and familial adenomatous polyposis in 2 (8.7{\%}) patients. Seven patients with mucosal ulcerative colitis were postoperatively diagnosed with Crohn's disease. Mean time interval from initial IPAA to development of symptomatic fistula was 17.2 months. Mean number of surgical treatments was 2.2. Overall, success was achieved in 17 (73.9{\%}) patients at a mean followup of 52.3 months. Fistulas in patients with Crohn's disease occurred relatively late after IPAA (p = 0.015) and required a median of three (p = 0.001) surgical procedures, compared with patients without Crohn's disease. Pelvic sepsis after original IPAA occurred in eight (35.8{\%}) patients, four (50{\%}) of whom ultimately required pouch excision. Conclusions: Fecal diversion and local procedures are effective in the majority of patients with PVF after IPAA. Patients with Crohn's disease tend to have a delayed onset of fistula occurrence and require more extensive surgical management. Pelvic sepsis can be a predictive factor of poor outcomes.",
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AU - Ruiz, Dan

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AU - Baig, Mirza K.

AU - Sands, Dana R.

AU - Weiss, Eric G.

AU - Nogueras, Juan J.

AU - Efron, Jonathan

AU - Vernava, Anthony M.

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