TREATMENT OF COLORECTAL AND ILEOANAL ANASTOMOTIC SINUSES

PURPOSE: This study is designed to describe a technique and report res ults for treating low anastomotic sinuses, METHODS: Restorative procto colectomy and complicated low anterior resections were protected with diverting loop ileostomy. Contrast enemas identified anastomotic probl ems before ileostomy closure, Pouch-anal or colorectal anastomotic sin uses that failed to resolve with observation were treated before intes tinal continuity was restored, With the patient receiving regional or general anesthesia, a rigid proctoscope or anoscope was used to identi fy the sinus opening. The common wall between the sinus and the bowel lumen was divided under direct vision with laparoscopic cautery scisso rs, and the sinus cavity was debrided with a suction cautery wand plac ed through the scope. RESULTS: Six patients with anastomotic sinuses h ave received outpatient treatment in the described manner during the p ast two years. Pour patients had restorative proctocolectomies for ulc erative colitis, and two had low anastomosis for rectal cancer. Three patients presented with pelvic sepsis before tile contrast study; the remainder were asymptomatic. Division of anastomotic sinus was perform ed one to eight months after diagnosis of the sinus. Following divisio n, anastomotic cavities resolved in five patients by I month and in on e patient by 12 months, in these six patients, there was one dilatable anastomotic stricture but no other anastomotic complications at follo w-up 5 to 16 (mean, 9.2) months after sinus division. CONCLUSION: When used in conjunction with fecal diversion, sinus unroofing by division of tile common wall between the sinus and bowel lumen treats low pelv ic sinuses.