The Management of Anastomotic Pouch Sinus After IPAA


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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.DESIGN:This research is a retrospective cohort study from a prospectively collected database.SETTING:The investigation took place in a high-volume specialized colorectal surgery department.PATIENTS:Patients with an anastomotic sinus after pouch surgery from 1997 to 2009 were included.MAIN OUTCOMES MEASURES: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.LIMITATIONS:This study was limited by its nonrandomized retrospective design.CONCLUSION: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.

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