Transanal circumferential pouch advancement for treatment of pouch vaginal fistulae.

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Techniques in Coloproctology Pub Date : 2024-08-14 DOI:10.1007/s10151-024-02983-7

M Obi, M Klingler, I Sapci, O Lavryk, J Lipman, S R Steele, T Hull, S D Holubar

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引用次数: 0

Abstract

Background: Ileal pouch anal anastomosis (IPAA) circumferential pouch advancement (CPA) involves full-thickness transanal 180-360° dissection of the distal pouch, allowing the advancement of healthy bowel to cover the internal opening of a vaginal fistula. We aimed to describe the long-term outcomes of this rare procedure.

Methods: Patients with IPAA who underwent transanal pouch advancement for any indication between 2009 and 2021 were included. Demographics, operative details, and outcomes were reviewed. An early fistula was defined as occurring within 1 year of IPAA construction. Clinical success was defined as resolution of symptoms necessitating CPA, pouch retention, and no stoma at the time of follow-up. Figures represent the median (interquartile range) or frequency (%).

Results: Over a 12-year period, nine patients were identified; the median age at CPA was 41 (36-44) years. Four patients developed early fistula after index IPAA, and five developed late fistulae. The median number of fistula repair procedures prior to CPA was 2 (1-2). All patients were diagnosed with ulcerative colitis at the time of IPAA and all late patients were re-diagnosed with Crohn's disease. Four (44.4%) patients had ileostomies present at the time of surgery, three (33.3%) had one constructed during surgery, and two (22.2%) never had a stoma. The median follow-up time was 11 (6-24) months. Clinical success was achieved in four of the nine (44.4%) patients at the time of the last follow-up.

Conclusions: Transanal circumferential pouch advancement was an effective treatment for refractory pouch vaginal fistulas and may be offered to patients who have had previous attempts at repair.

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经肛门环形肛袋推进术治疗肛袋阴道瘘。

背景：回肠肠袋肛门吻合术（IPAA）环形肠袋推进术（CPA）包括对远端肠袋进行全厚经肛门180-360°剥离，从而推进健康肠道以覆盖阴道瘘的内口。我们旨在描述这种罕见手术的长期效果：方法：纳入 2009 年至 2021 年期间因任何适应症接受经肛门肠袋推进术的 IPAA 患者。我们回顾了人口统计学、手术细节和结果。早期瘘管的定义是在IPAA构建后1年内发生的瘘管。临床成功的定义是：在随访时，需要进行 CPA 的症状消失、肛袋保留、无造口。数字代表中位数（四分位间范围）或频率（%）：在 12 年的时间里，共发现了 9 名患者；CPA 时的中位年龄为 41（36-44）岁。四名患者在指数IPAA后出现早期瘘管，五名患者出现晚期瘘管。CPA 之前瘘管修复手术的中位数为 2 次（1-2 次）。所有患者在进行IPAA时都被诊断为溃疡性结肠炎，所有晚期患者都被再次诊断为克罗恩病。四名患者（44.4%）在手术时就有回肠造口，三名患者（33.3%）在手术时就建有回肠造口，两名患者（22.2%）从未有过造口。中位随访时间为 11（6-24）个月。最后一次随访时，9 位患者中有 4 位（44.4%）获得了临床成功：结论：经肛门环形肛袋推进术是治疗难治性肛袋阴道瘘的有效方法，可以提供给以前尝试过修复的患者。

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来源期刊

Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.30

自引率

9.10%

发文量

176

审稿时长

1 months

期刊介绍： Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.