OUTCOME OF THE PELVIC POUCH PROCEDURE IN PATIENTS WITH PRIOR PERIANALDISEASE

PURPOSE: There is concern that patients with presumed ulcerative colit is and significant perianal disease may in fact have Crohn's disease. Moreover, prior perianal disease may be an independent factor for poor outcome of the pelvic pouch. The aim of this study was to evaluate th e effect of prior perianal disease on pelvic pouch outcome. METHODS: B etween 1982 and 1994, 52 of 753 patients (6.9 percent) who had a pelvi c pouch procedure were prospectively identified as having perianal dis ease. Outcome of the pelvic pouch of these 52 patients (Group I) were compared with the outcome of 701 pelvic pouch patients with no prior p erianal disease (Group II). The perianal diseases identified in Group I were fissure-in-ano (17), perianal abscesses (13), fistula-in-ano (7 ), rectovaginal fistula (3), and significant hemorrhoids/skin tags (25 ). Eleven patients (21 percent) had more than one type of perianal dis ease. Twenty-seven patients (52 percent) required a total of 33 perian al operations for the different anal pathologies. RESULTS: Both groups were comparable for the following characteristics: age at time of pel vic pouch procedure, pathology (ulcerative colitis or indeterminate co litis), design of pouch, and type of ileoanal anastomosis (handsewn or stapled). An ileoanal anastomosis leak developed in 21 percent of pat ients (n = 11) in Group I vs. 11.4 percent (n = 80) in Group II (P < 0 .05). Perianal postoperative complications occurred in 11.5 percent of patients (n = 6) in Group I vs. 1.7 percent (n = 12) in Group II (P < 0.05). Total pouch failure rate was not significantly different betwe en the two groups (11.5 vs. 7.6 percent; P > 0.05). Crohn's disease wa s subsequently diagnosed in 1.9 vs. 2.7 percent (P > 0.05). Subgroup a nalysis of Group I patients showed no significant difference in outcom e according to type of perianal lesion or a history of perianal surger y. CONCLUSION: Prior perianal disease significantly increases the risk of developing an ileoanal anastomotic leak and postoperative perianal complications. However, a pelvic pouch procedure may be an acceptable surgical alternative for selected ulcerative colitis patients with pr ior perianal disease because the overall pouch failure rate is not sig nificantly increased.