Ileal pouch-anal anastomosis. Patterns of failure.
During the period from 1980 through 1990, our institution constructed 253 ileoanal reservoirs in 253 patients, of whom 25 (9.9%) experienced pouch failure. A poor functional result was the most common cause of pouch failure (seven [28%] of 25 patients). Unsuspected Crohn's disease became manifest in 13 (5%) of the 253 patients, resulting in pouch loss due to perianal sepsis or pouch fistulas in six patients (24% of 25 failures), and resulted in a significantly increased risk of pouch failure compared with that of the non-Crohn's population. Pouchitis occurred in 78 patients (31%) and accounted for four (16%) of 25 failures, but patients with pouchitis were not at higher risk for pouch failure than were patients who did not have pouchitis (failure rates of 6.4% vs 10.4%, respectively; not significant). Significant pelvic sepsis in the absence of Crohn's disease developed in 13 patients, five (38%) of whom lost their pouches. Poor functional results, pelvic sepsis, and unsuspected Crohn's disease were the major causes of pouch failure, while pouchitis was not.
Gemlo
B T
BT
Department of Surgery, University of Minnesota, Minneapolis.
Wong
W D
WD
Rothenberger
D A
DA
Goldberg
S M
SM
D000367:Age Factors; D003424:Crohn Disease / Q000150:complications / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008910:Minnesota / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D016737:Proctocolectomy, Restorative / Q000009:adverse effects / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors; D013530:Surgical Wound Infection / Q000150:complications / Q000453:epidemiology; D013997:Time Factors