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Transanal circumferential pouch advancement for treatment of pouch vaginal fistulae.
Obi, M; Klingler, M; Sapci, I; Lavryk, O; Lipman, J; Steele, S R; Hull, T; Holubar, S D.
Afiliación
  • Obi M; Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
  • Klingler M; Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Main Campus, 9500, Cleveland, OH, 44122, USA.
  • Sapci I; Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
  • Lavryk O; Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Main Campus, 9500, Cleveland, OH, 44122, USA.
  • Lipman J; Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Main Campus, 9500, Cleveland, OH, 44122, USA.
  • Steele SR; Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Main Campus, 9500, Cleveland, OH, 44122, USA.
  • Hull T; Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Main Campus, 9500, Cleveland, OH, 44122, USA.
  • Holubar SD; Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Main Campus, 9500, Cleveland, OH, 44122, USA. holubas@ccf.org.
Tech Coloproctol ; 28(1): 105, 2024 Aug 14.
Article en En | MEDLINE | ID: mdl-39141140
ABSTRACT

BACKGROUND:

Ileal pouch anal anastomosis (IPAA) circumferential pouch advancement (CPA) involves full-thickness transanal 180-360° dissection of the distal pouch, allowing the advancement of healthy bowel to cover the internal opening of a vaginal fistula. We aimed to describe the long-term outcomes of this rare procedure.

METHODS:

Patients with IPAA who underwent transanal pouch advancement for any indication between 2009 and 2021 were included. Demographics, operative details, and outcomes were reviewed. An early fistula was defined as occurring within 1 year of IPAA construction. Clinical success was defined as resolution of symptoms necessitating CPA, pouch retention, and no stoma at the time of follow-up. Figures represent the median (interquartile range) or frequency (%).

RESULTS:

Over a 12-year period, nine patients were identified; the median age at CPA was 41 (36-44) years. Four patients developed early fistula after index IPAA, and five developed late fistulae. The median number of fistula repair procedures prior to CPA was 2 (1-2). All patients were diagnosed with ulcerative colitis at the time of IPAA and all late patients were re-diagnosed with Crohn's disease. Four (44.4%) patients had ileostomies present at the time of surgery, three (33.3%) had one constructed during surgery, and two (22.2%) never had a stoma. The median follow-up time was 11 (6-24) months. Clinical success was achieved in four of the nine (44.4%) patients at the time of the last follow-up.

CONCLUSIONS:

Transanal circumferential pouch advancement was an effective treatment for refractory pouch vaginal fistulas and may be offered to patients who have had previous attempts at repair.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Colitis Ulcerosa / Fístula Vaginal / Proctocolectomía Restauradora / Reservorios Cólicos Límite: Adult / Female / Humans Idioma: En Revista: Tech Coloproctol Asunto de la revista: GASTROENTEROLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Italia
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Colitis Ulcerosa / Fístula Vaginal / Proctocolectomía Restauradora / Reservorios Cólicos Límite: Adult / Female / Humans Idioma: En Revista: Tech Coloproctol Asunto de la revista: GASTROENTEROLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Italia