What happens to a pelvic pouch when a fistula develops?
OBJECTIVE
The aim of this article is to determine the outcome of the pelvic pouch after the occurrence of a fistula.


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).


CONCLUSIONS
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.
Ozuner
G
G
Department of Colon and Rectal Surgery, Cleveland Clinic Foundation, Ohio, USA.
Hull
T
T
Lee
P
P
Fazio
V W
VW
D000328:Adult; D003093:Colitis, Ulcerative / Q000601:surgery; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery; D005260:Female; D005402:Fistula / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D010502:Perineum; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D017211:Treatment Failure; D014624:Vaginal Fistula / Q000209:etiology / Q000601:surgery