Management and Outcome of Pouch-Vaginal Fistulas Following Restorative Proctocolectomy

Heriot, Alexander G.; Tekkis, Paris; Smith, Jason; Bona, R.; Cohen, Richard G.; Nicholls, R. J.

doi:10.1007/s10350-004-0902-7

Cited by 85 publications

(52 citation statements)

References 24 publications

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“…Ileal pouch fistulas are an uncommon and devastating complication for patients, and a challenging problem for surgeons. Several studies have assessed ileal pouch-vaginal fistula formation after RPC with IAA [16][17][18][19][20], but little has been published on overall perianal fistula formation after RPC.…”

Section: Discussionmentioning

confidence: 99%

Ileal pouch fistulas after restorative proctocolectomy: management and outcomes

et al. 2014

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Section: Discussionmentioning

confidence: 99%

Ileal pouch fistulas after restorative proctocolectomy: management and outcomes

et al. 2014

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“…Heriot AG et al [19] reported recurrence in 27 of 45 (60 %) patients who underwent primary repair. In our study, pouchvaginal fistulae developed in three patients after restorative proctocolectomy and were successfully repaired in two.…”

Section: Discussionmentioning

confidence: 99%

Complex Rectovaginal Fistula—an Experience at a Tertiary Care Centre

et al. 2015

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Complex rectovaginal fistulae are difficult to manage. With an initial failed attempt, a simple fistula becomes complex and the success rate of a subsequent repair decreases. A review of our prospectively maintained records over a period of 16 years revealed 25 patients with rectovaginal fistulae. A variety of procedures was performed in these patients according to their aetiology, site and if there had been a previous attempt at repair. The mean age of the patients was 45 years. The most common cause was operative trauma in 14 cases. Ten patients had previous attempts at repair which had not been successful. The surgical procedures we performed included re-enforcement flaps, resection with diversion, repair with re-enforcement with omentum and simple diversion. Two patients developed recurrence, and one of them healed after a second repair. No recurrence developed in 10 patients who had failed attempts at repair elsewhere. Our experience has shown that most complex rectovaginal fistulae can be successfully repaired but they might require repeated operations. Faecal diversion is usually necessary, and in recurrent fistulae, we found that rather than a local repair, a muscle flap or omental interposition improves the chances of healing.

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“…24,34 Local procedures are suitable for PVF originating below the IPAA, and include transanal or transvaginal advancement full-thickness flap repair. Primary closure rate is below 60%, 34,35 but transvaginal repair allows direct access to the fistula, avoiding sphincter damage.…”

Section: Septic Complicationsmentioning

confidence: 99%

“…33 The approach depends on the site of PVF. 34 Abdominal repairs are needed for PVF originating above the IPAA, and mainly consist of pouch revision or redo, with primary repair of the vaginal defect, resection of the potentially retained rectum, mucosectomy, and advancement of the IPAA below the level of the fistula. 34 Primary healing is reported in 67-80% of patients.…”

Section: Septic Complicationsmentioning

confidence: 99%

“…34 Abdominal repairs are needed for PVF originating above the IPAA, and mainly consist of pouch revision or redo, with primary repair of the vaginal defect, resection of the potentially retained rectum, mucosectomy, and advancement of the IPAA below the level of the fistula. 34 Primary healing is reported in 67-80% of patients. 24,34 Local procedures are suitable for PVF originating below the IPAA, and include transanal or transvaginal advancement full-thickness flap repair.…”

Section: Septic Complicationsmentioning

confidence: 99%

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Outcomes of Salvage Surgery for Ileal Pouch Complications and Dysfunctions. The Experience of a Referral Centre and Review of Literature

Pellino¹,

Selvaggi²

2015

ECCOJC

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Background and Aims: Failure rates of restorative proctocolectomy with ileo pouch-anal anastomosis (IPAA) range between 3.5 and 15%. Salvage surgery aims to preserve the pouch and transanal evacuation. We report our experience with salvage, review the outcomes of revisional pouch surgery, and propose a classification of pouch dysfunction. Methods: We collected data on patients undergoing pouch salvage surgery between 1987 and 2014 at our hospital. Pre-and post-salvage functional data were assessed. Function at the 3-year follow-up was compared with that of matched IPAA controls (study patients:controls, 1:3). Results: Considering only patients who underwent primary IPAA at our centre (n = 31), 5-year failure was higher after salvage compared with primary IPAA (28.8 vs 5.7% log rank test, p = 0.005). Overall, we included 39 patients, with eight additional patients who received primary IPAA elsewhere, undergoing 46 procedures. Most patients had a J-pouch (74.4%) and needed salvage for septic complications. A transperineal approach was used in 22 patients, whereas 17 underwent abdominal salvage, with 77.3 and 64.7% success rates, respectively. Minor surgery was effective but required repeated procedures. Overall failure was 28.2% at a median follow-up of 42 (1-153) months. A significant decrease in bowel frequency (p = 0.021) and rate of urgency (p = 0.009) was observed at the 3-year follow-up after salvage in 25 patients available for comparison. Functional results after major salvage procedures were poorer compared with healthy IPAA controls (p = 0.003). Conclusions: Salvage surgery is effective and safe in experienced teams, but the 5-year failure rate is higher after salvage than after successful primary pouch surgery. Sepsis brings about a higher risk of failure compared with mechanical causes of dysfunction.

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Management and Outcome of Pouch-Vaginal Fistulas Following Restorative Proctocolectomy

Cited by 85 publications

References 24 publications

Ileal pouch fistulas after restorative proctocolectomy: management and outcomes

Ileal pouch fistulas after restorative proctocolectomy: management and outcomes

Complex Rectovaginal Fistula—an Experience at a Tertiary Care Centre

Outcomes of Salvage Surgery for Ileal Pouch Complications and Dysfunctions. The Experience of a Referral Centre and Review of Literature

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