Pouch-vaginal fistula after proctocolectomy and ileal pouch anal anastomosis. Management and evolution

Abstract

Background: pouchvaginal fistula is an infrequency postoperative complication after proctocolectomy with ileoanal reservoire and occasionally one of the cause of failure of this surgery. Its appearance is associated with several factors. The fistula can close spontaneously or keeping the ileostomy open and, in some cases, requieres several surgical procedures.
Objective: to present pouch vaginal fistula’s prevalence, associated factors with its appearance, treatments and outcomes.
Setting: Hospital de Gastroenterología Dr. Carlos Bonorino Udaondo.
Design: retrospective descriptive observational.
Outcome measures: statistical significance Fisher´s exact test.
Population and methods: from 1987 to September 2012 were operated 262 women doing proctocolectomy and ileoanal pouch, follow-up: median 87,8 months (range: 0,3-252). History clinic and data
base revision providing prevalence, time of appearance before or after ileostomy closure, technical difficulties, postoperative complications associated, no suspected Crohn´s disease, manual or mechanical anastomosis, spontaneously closure, keeping ileostomy , surgery, success or failure therapeutic.
Results: 28 patients with pouchvaginal fistula (10,3%), median age 30,5 years (range: 17-58), 9 change diagnosis from ulcerative colitis to Crohn´s disease, 42,8% appearance before ileostomy closure, 57% postoperative complications associated, 25% technical difficulties, in 5 cases the fistula closed keeping the ileostomy open and 3 with expectancy after ileostomy closure, 16 patients were operated, 10 new ileostomy and 17 anovaginal procedures, 4 received inmunosupressors, with 2 closure, 48% successful treatment, but 8 continue with proposal to treatment. The fistula´s appearance was statistically significant in patients with Crohn´s disease and those with associated complications specially pelvic sepsis.