FUNCTIONAL RESULTS AFTER PERINEAL COMPLICATIONS OF ILEAL POUCH-ANAL ANASTOMOSIS

PURPOSE: This study investigated the functional significance of perine al complications after ileal pouch-anal anastomosis. METHODS: Review o f a prospective registry of 628 patients was undertaken. Bowel functio n was assessed by detailed functional questionnaire. Statistical analy ses were performed using chi-squared and Fisher's exact probability te sts. RESULTS: Of 628 patients, 153 (24.4 percent) had 171 perineal com plications. The 277 control patients had no complications. Complicatio ns included 66 (10.5 percent) anastomotic strictures, 28 (4.5 percent) anastomotic separations, 36 (5.7 percent) pouch fistulas, 41 (6.5 per cent) episodes of pelvic sepsis, and 18 (2.9 percent) patients with mu ltiple complications. After these complications were addressed, the po uch failure rate was low (10 percent); in 90 percent of patients, the pouch could be salvaged. Most pouch failures were the result of pouch fistulas, and most occurred in patients ultimately diagnosed with Croh n's disease. Functional results after cure of these perineal complicat ions revealed no significant functional differences between control pa tients and those cured of anastomotic separations, anastomotic strictu res, and pouch fistulas. Only a few minor differences were demonstrate d in function after an episode of pelvic sepsis. The major deteriorati on in function occurred after treatment for multiple perineal complica tions. CONCLUSIONS: An appreciable number of perineal complications oc cur after ileal pouch-anal anastomosis. Pouch-perineal fistulas are as sociated with the highest pouch failure rate. The majority of these fi stulas occur in patients ultimately diagnosed with Crohn's disease or indeterminate colitis. Although there is no substitute for good techni que and sound clinical judgment in the success of ileal pouch-anal ana stomosis, if perineal complications are successfully treated, function al outcome is equivalent to that in patients without perineal complica tions.