Abstract
Background
Ileoanal pouch related fistulae (PRF) are a complication of restorative proctocolectomy
often requiring repeated surgical interventions and with a high risk of long-term
recurrence and pouch failure.
Aims
To assess the incidence of PRF and to report on the outcomes of available surgical
treatments.
Methods
A PRISMA-compliant systematic literature search for articles reporting on PRF in patients
with inflammatory bowel diseases (IBD) or familial adenomatous polyposis (FAP) from
1985 to 2020.
Results
34 studies comprising 770 patients with PRF after ileal-pouch anal anastomosis (IPAA)
were included. Incidence of PRF was 1.5-12%. In IBD patients Crohn's Disease (CD)
was responsible for one every four pouch-vaginal fistulae (PVF) (OR 24.7; p=0.001).
The overall fistula recurrence was 49.4%; procedure-specific recurrence was: repeat
IPAA (OR 42.1; GRADE +); transvaginal repair (OR 52.3; GRADE ++) and transanal ileal
pouch advancement flap (OR 56.9; GRADE ++). The overall failure rate was 19%: pouch
excision (OR 0.20; GRADE ++); persistence of diverting stoma (OR 0.13; GRADE +) and
persistent fistula (OR 0.18; GRADE +).
Conclusion
PVFs are more frequent compared to other types of PRF and are often associated to
CD; surgical treatment has a risk of 50% recurrence. Repeat IPAA is the best surgical
approach with a 42.1% recurrence rate.
Keywords
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Article info
Publication history
Published online: June 07, 2022
Accepted:
May 15,
2022
Received:
March 12,
2022
Identification
Copyright
© 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
