Ileoanal pouch-related fistulae: A systematic review with meta-analysis on incidence, treatment options and outcomes

Autor: Gianluca Pellino, Valerio Celentano, Danilo Vinci, Francesco Maria Romano, Agnese Pedone, Vincenzo Vigorita, Giuseppe Signoriello, Francesco Selvaggi, Guido Sciaudone
Přispěvatelé: Pellino, Gianluca, Celentano, Valerio, Vinci, Danilo, Romano, Francesco Maria, Pedone, Agnese, Vigorita, Vincenzo, Signoriello, Giuseppe, Selvaggi, Francesco, Sciaudone, Guido
Rok vydání: 2023
Předmět:
Zdroj: Digestive and Liver Disease. 55:342-349
ISSN: 1590-8658
Popis: Ileoanal pouch related fistulae (PRF) are a complication of restorative proctocolectomy often requiring repeated surgical interventions and with a high risk of long-term recurrence and pouch failure.To assess the incidence of PRF and to report on the outcomes of available surgical treatments.A PRISMA-compliant systematic literature search for articles reporting on PRF in patients with inflammatory bowel diseases (IBD) or familial adenomatous polyposis (FAP) from 1985 to 2020.34 studies comprising 770 patients with PRF after ileal-pouch anal anastomosis (IPAA) were included. Incidence of PRF was 1.5-12%. In IBD patients Crohn's Disease (CD) was responsible for one every four pouch-vaginal fistulae (PVF) (OR 24.7; p=0.001). The overall fistula recurrence was 49.4%; procedure-specific recurrence was: repeat IPAA (OR 42.1; GRADE +); transvaginal repair (OR 52.3; GRADE ++) and transanal ileal pouch advancement flap (OR 56.9; GRADE ++). The overall failure rate was 19%: pouch excision (OR 0.20; GRADE ++); persistence of diverting stoma (OR 0.13; GRADE +) and persistent fistula (OR 0.18; GRADE +).PVFs are more frequent compared to other types of PRF and are often associated to CD; surgical treatment has a risk of 50% recurrence. Repeat IPAA is the best surgical approach with a 42.1% recurrence rate.
Databáze: OpenAIRE
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