Pouch-related fistula and intraoperative tricks to prevent it

Excerpt

Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the mainstay of treatment for refractory ulcerative colitis (UC) or dysplasia in chronic UC. In spite of the advances in the medical treatment for UC, up to 30 % of patients may still require surgery [1]. Irrespective of age at surgery and disease duration [2, 3], IPAA achieves optimal functional results, and this is reflected in health-related quality of life (HRQoL). Early postoperative pelvic sepsis, which is responsible for significant functional disturbances [4] and impaired HRQoL in the long term [1‐6], is the most dreaded complication of IPAA [4, 5]. Up to 25 % of IPAA patients are affected to some degree [1‐7] and are at greater risk of pouch-related fistula. The risk of pelvic sepsis is inversely proportional to the surgeon’s experience with pouch surgery, suggesting that some factors responsible for pelvic sepsis and late formation of pouch-related fistulae are modifiable. …