Risk factors for pelvic pouch failure

• Published in: Diseases of the colon & rectum Vol. 40; no. 3; pp. 257 - 262
• Main Authors: MACRAE, H. M, MCLEOD, R. S, COHEN, Z, O'CONNOR, B. I, NG CHEONG TON, E
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Secaucus, NJ Springer 01.03.1997
• Subjects: Adult; Biological and medical sciences; Female; Follow-Up Studies; Humans; Incidence; Male; Medical sciences; Proctocolectomy, Restorative - adverse effects; Proctocolectomy, Restorative - methods; Prognosis; Retrospective Studies; Risk Factors; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Surgical Stapling; Suture Techniques; Time Factors; Treatment Failure; Human; Rupture; Surgical anastomosis; Surgical resection; Reservoir; Familial adenomatous polyposis coli; Statistical study; Genetic disease; Inflammatory disease; Treatment; Surgery; Risk factor; Digestive diseases; Intestinal disease; Complication; Benign neoplasm; Ulcerative colitis
• ISSN: 0012-3706; 1530-0358
• DOI: 10.1007/BF02050412

This study was designed to identify factors associated with pelvic pouch failure. A retrospective review of patients undergoing the pelvic pouch procedure with a minimum of 30 months follow-up was conducted. A total of 551 patients had pelvic pouch procedures from 1981 to 1992. Forty-nine patients (8.8 percent) have undergone pouch excision, and 9 (1.6 percent) have been defunctioned, for 58 (10.5 percent) patients with pouch failure. Cause of failure was leakage from the ileoanal anastomosis (IAA) in 21 (39 percent) patients, poor functional results in 13 (23 percent), pouchitis in 7 (12 percent), pouch leakage in 7 (12 percent), perianal disease in 7 (12 percent), and miscellaneous in 3 (5.2 percent). Nine of 22 patients (41 percent) had pouch failure during the first two years, with 2 of 147 patients (1 percent) having failure during the last two years of the study. The 58 patients whose pouches failed (Group 1) were compared with the 493 patients whose pouches did not fail (Group 2). Handsewn IAA (P < 0.001), tension on the IAA (P < 0.001), use of a defunctioning ileostomy (P < 0.01), a diagnosis of Crohn's disease (P < 0.001), and a leak from the pouch (P < 0.001) or the IAA (P < 0.001) were associated with pouch failure. Pouchitis was not a risk factor. The majority of pouch failures were caused by leaks at the IAA. Although the leak rate remained stable, leaks following a stapled anastomosis seemed to have a better prognosis than leaks following a handsewn anastomosis. Experience with the pouch procedure and the management of complications likely plays an important role in decreasing the risk of pouch failure.