| The Management of Anastomotic Pouch Sinus After IPAA. | |
| | |
MedLine Citation:
|
PMID: 22513432 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
|
BACKGROUND: : Anastomotic sinus is a relatively uncommon complication after an IPAA. Disease course is poorly defined, and management can be challenging. OBJECTIVE: : The purpose of this study was to evaluate the frequency, management, and outcome of anastomotic pouch sinus. DESIGN: : This research is a retrospective cohort study from a prospectively collected database. SETTING: : The investigation took place in a high-volume specialized colorectal surgery department. PATIENTS: : Patients with an anastomotic sinus after pouch surgery from 1997 to 2009 were included. MAIN OUTCOMES MEASURES: : The primary outcomes measured were sinus healing and pouch failure. RESULTS: : Of 2286 patients who underwent an IPAA, 45 (2.0%) patients were identified with an anastomotic pouch sinus. There were 32 (71%) males, and the mean age was 40 (±13) years. The pouch sinus was initially managed by observation in 23 (51%) patients, drainage of the sinus in 9 (20%) patients, unroofing of the sinus tract in 8 (18%) patients, sinus closure in 3 (7%) patients, and a diverting ileostomy in 2 (4%) patients. In 28 patients (62%), subsequent treatment was necessary. Sinus healing was achieved in 27 (60%) patients, whereas 15 (33%) eventually developed pouch failure. Of the treatment modalities applied, a strategy with observation as initial treatment was the most successful with a healing rate of 65%. The healing rate was significantly lower in symptomatic patients in comparison with asymptomatic patients (30% vs 84%, p = 0.001). Pouch failure was also higher (45% vs 24%, p = 0.14). No other factors associated with healing rate or pouch failure were identified. LIMITATIONS: : This study was limited by its nonrandomized retrospective design. CONCLUSION: : Anastomotic pouch sinuses after pouch surgery are associated with a high rate of pouch failure. Symptomatic presentation is a significant predictor for low healing rates and is associated with a high risk of pouch failure. Observation and watchful monitoring is the initial treatment of choice when permitted by the patient's condition. |
| | |
Authors:
|
Usama Ahmed Ali; Bo Shen; Feza H Remzi; Ravi P Kiran |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: Diseases of the colon and rectum Volume: 55 ISSN: 1530-0358 ISO Abbreviation: Dis. Colon Rectum Publication Date: 2012 May |
Date Detail:
|
Created Date: 2012-04-19 Completed Date: - Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0372764 Medline TA: Dis Colon Rectum Country: United States |
Other Details:
|
Languages: eng Pagination: 541-8 Citation Subset: IM |
Affiliation:
|
1Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 2Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Genetic variation in the transforming growth factor-?-signaling pathway, lifestyle factors, and risk...
Next Document: Increased crypt apoptosis is a feature of autoimmune-associated chronic antibiotic refractory pouchi...