POUCH-RELATED FISTULA FOLLOWING RESTORATIVE PROCTOCOLECTOMY

Prognostic factors and outcome of pouch-related fistula were analysed from a series of 21 patients, 20 of whom had an ileal J pouch manually anastomosed to the dentate line following mucosectomy. Fistula occurr ed more often after pouch formation for ulcerative colitis than for fa milial adenomatous polyposis. In 6 patients the fistula occurred more than 5 months after closure of the diverting loop ileostomy. The origi n of the leak was the anastomosis in 14 patients, the vertical staple line in two and the end of the efferent limb in five. Nine forms of tr eatment were utilized and these were successful in 11 patients and uns uccessful in ten including three pouch excisions. Adverse prognostic f actors were late fistula, the presence of an enterocutaneous or a pouc h-vaginal fistula track, and diagnosed or suspected Crohn's disease, R esolution of the fistula followed none of six diverting loop ileostomi es performed alone, three of 33 attempted drainage procedures, four of ten direct closures, and four of five repeat ileal pouch-anal anastom oses. It is concluded that an aggressive therapeutic approach using re peat ileal pouch-anal anastomosis increases the success rate.