Pouch-vaginal fistula after ileal pouch-anal anastomosis: treatment and outcomes.
OBJECTIVE
Pouch-vaginal fistula is an uncommon but serious complication after ileal pouch anal anastomosis. The management of pouch-vaginal fistulas is challenging and a number of treatment options exist. The purpose of this study was to examine the outcomes after various procedures for pouch-vaginal fistula performed at our institution.


METHODS
Patients who were treated for pouch-vaginal fistula at Mount Sinai Hospital were identified from a prospectively maintained database. Demographic, disease history, treatment, and outcomes data were obtained. Treatment success was defined as no recurrence of the fistula with a functioning pouch and no ileostomy.


RESULTS
Since November 1982, 24 of 619 (3.9 percent) women who had primary ileal pouch-anal anastomosis performed at Mount Sinai Hospital developed a pouch-vaginal fistula. Five women had ileal pouch-anal anastomosis performed at another institution and were referred for management of their pouch-vaginal fistula. Local and/or combined abdominoperineal repairs were performed in 22 of 29 patients. Combined abdominoperineal repairs were associated with a higher success rate than that of local perineal repairs (52.9 vs. 7.9 percent, respectively, at 10 years after repair; p = 0.035). Overall, 50 percent (11/22) of patients who underwent surgical repair of a pouch-vaginal fistula had a successful result with a functioning pouch and no recurrence of the fistula, and 21 percent (6/29) of patients required pouch excision.


CONCLUSIONS
The management of pouch-vaginal fistula after ileal pouch-anal anastomosis is associated with a high recurrence rate. Combined abdominoperineal repair appears to offer better results than those of local procedures.
Johnson
Paul M
PM
IBD Research Unit, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
O'Connor
Brenda I
BI
Cohen
Zane
Z
McLeod
Robin S
RS
D000005:Abdomen / Q000601:surgery; D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects; D039021:Colonic Pouches / Q000009:adverse effects*; D005260:Female; D006801:Humans; D010502:Perineum / Q000601:surgery; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D014624:Vaginal Fistula / Q000209:etiology* / Q000601:surgery*