Does technique of anastomosis play any role in developing late perianal abscess or fistula?

PURPOSE: This study examines the risk factors for developing perianal absce ss or fistula formation after ileal pouchanal anastomosis procedure for chr onic ulcerative colitis or familial adenomatous polyposis. METHODS: A total of 1,457 patients with J-pouch, 1,304 (89.5 percent) with chronic ulcerati ve colitis and 153 (10.5 percent) with familial adenomatous polyposis who h ad a two-stage procedure without any evidence of previous perianal disease were included in the study. The effect of pouch-to-anal anastomosis type on perianal abscess or fistula formation was evaluated. RESULTS: A total of 1 08 patients (7.4 percent) had a perianal abscess or fistula after the ileal pouch-anal anastomosis procedure after at least one year of follow-up. No statistically significant difference was identified in fistula formation re garding the age and gender of the patients (P > 0.05), nor did the risk of fistula formation differ significantly between the patients with handsewn v s. stapled anastomoses (P > 0.05). However, patients with a diagnosis of ch ronic ulcerative colitis, compared with patients with familial adenomatous polyposis, had a statistically higher risk of developing abscess or fistula (P = 0.012). CONCLUSION: The most important risk factor in developing peri anal sepsis in long-term patients with ileal pouch-anal anastomosis is the initial disease type. After excluding patients without Crohn's disease, the risk of developing an abscess or fistula was found to be significantly gre ater in patients with chronic ulcerative colitis compared with patients wit h familial adenomatous polyposis, and this risk is independent of anastomot ic technique.