title: The management of anastomotic pouch sinus after IPAA.
abstract: BACKGROUND
  Anastomotic sinus is a relatively uncommon complication after an IPAA. Disease course is poorly defined, and management can be challenging.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the frequency, management, and outcome of anastomotic pouch sinus.
  
  
  METHODS
  This research is a retrospective cohort study from a prospectively collected database.
  
  
  METHODS
  The investigation took place in a high-volume specialized colorectal surgery department.
  
  
  METHODS
  Patients with an anastomotic sinus after pouch surgery from 1997 to 2009 were included.
  
  
  METHODS
  The primary outcomes measured were sinus healing and pouch failure.
  
  
  RESULTS
  Of 2286 patients who underwent an IPAA, 45 (2.0%) patients were identified with an anastomotic pouch sinus. There were 32 (71%) males, and the mean age was 40 (±13) years. The pouch sinus was initially managed by observation in 23 (51%) patients, drainage of the sinus in 9 (20%) patients, unroofing of the sinus tract in 8 (18%) patients, sinus closure in 3 (7%) patients, and a diverting ileostomy in 2 (4%) patients. In 28 patients (62%), subsequent treatment was necessary. Sinus healing was achieved in 27 (60%) patients, whereas 15 (33%) eventually developed pouch failure. Of the treatment modalities applied, a strategy with observation as initial treatment was the most successful with a healing rate of 65%. The healing rate was significantly lower in symptomatic patients in comparison with asymptomatic patients (30% vs 84%, p = 0.001). Pouch failure was also higher (45% vs 24%, p = 0.14). No other factors associated with healing rate or pouch failure were identified.
  
  
  CONCLUSIONS
  This study was limited by its nonrandomized retrospective design.
  
  
  CONCLUSIONS
  Anastomotic pouch sinuses after pouch surgery are associated with a high rate of pouch failure. Symptomatic presentation is a significant predictor for low healing rates and is associated with a high risk of pouch failure. Observation and watchful monitoring is the initial treatment of choice when permitted by the patient's condition.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Usama
authors.initials: U
authors.lastname: Ahmed Ali
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects; D039021:Colonic Pouches / Q000009:adverse effects*; D019468:Disease Management; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009820:Ohio / Q000453:epidemiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies