title: Anastomotic sinuses after ileoanal pouch construction: incidence, management, and outcome.
abstract: OBJECTIVE
  This study was designed to analyze the incidence, management, and outcome of pouch sinuses after ileal pouch-anal anastomosis at one institution.
  
  
  METHODS
  We identified 282 ileal pouch-anal anastomosis patients between 1992 and 2002 who had a pouchogram before planned ileostomy closure. The management and outcome of patients with pouchograms revealing pouch sinuses were reviewed.
  
  
  RESULTS
  Twenty-two patients (7.8 percent) had a pouch sinus at pouchogram. Nineteen patients were observed and underwent repeat pouchogram. Of these, ten had sinus resolution (mean, 3.6 months) and underwent successful ileostomy closure. Eight patients underwent examination under anesthesia +/- sinus debridement. Six of these patients had subsequent pouchograms with five showing sinus resolution. The patient without resolution was not reversed. Of the eight patients who underwent examination under anesthesia +/- debridement, seven underwent ileostomy closure (mean, 4.9 months), with healing in six and pelvic sepsis in one. Four patients underwent successful ileostomy takedown despite persistent sinus. Overall, 21 of the 22 pouch sinus patients underwent ileostomy closure and only 1 had postoperative pelvic sepsis.
  
  
  CONCLUSIONS
  Pouch sinuses after ileal pouch-anal anastomosis with ileostomy are uncommon. Most heal within six months. The majority of patients with sinuses eventually undergo successful ileostomy closure. Pelvic septic complications are rare but can occur despite sinus healing on pouchogram.
authors.affiliation: Department of Surgery, Division of Colon & Rectal Surgery, University of Minnesota, Minneapolis, Minnesota, USA. robertakbari@catholichealth.net
authors.forename: Robert P
authors.initials: RP
authors.lastname: Akbari
authors.forename: Robert D
authors.initials: RD
authors.lastname: Madoff
authors.forename: Susan C
authors.initials: SC
authors.lastname: Parker
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Hagerman
authors.forename: Shigeki
authors.initials: S
authors.lastname: Minami
authors.forename: Kelli M
authors.initials: KM
authors.lastname: Bullard Dunn
authors.forename: Anders F
authors.initials: AF
authors.lastname: Mellgren