Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy; Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.
Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom; Department of Surgery and Cancer. Imperial College, London, United Kingdom.
Dig Liver Dis. 2023 Mar;55(3):342-349. doi: 10.1016/j.dld.2022.05.009. Epub 2022 Jun 7.
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.
回肠贮袋肛门吻合术后相关瘘管（PRF）是修复性直肠结肠切除术的一种并发症，常需要反复手术干预，且长期复发和贮袋失败的风险较高。
评估 PRF 的发生率，并报告现有手术治疗的结果。
按照 PRISMA 指南，对 1985 年至 2020 年期间报道炎症性肠病（IBD）或家族性腺瘤性息肉病（FAP）患者 PRF 的文章进行系统的文献检索。
共纳入 34 项研究，包含 770 例回肠贮袋肛门吻合术后发生 PRF 的患者。PRF 的发生率为 1.5-12%。在 IBD 患者中，克罗恩病（CD）每 4 个贮袋-阴道瘘（PVF）中就有 1 个（OR 24.7；p=0.001）。总体瘘管复发率为 49.4%；具体手术的复发率为：重复 IPAA（OR 42.1；GRADE +）；经阴道修补（OR 52.3；GRADE ++）和经肛门回肠贮袋推进皮瓣（OR 56.9；GRADE ++）。总体失败率为 19%：贮袋切除（OR 0.20；GRADE ++）；转流性造口持续存在（OR 0.13；GRADE +）和持续性瘘管（OR 0.18；GRADE +）。
与其他类型的 PRF 相比，PVF 更为常见，且常与 CD 相关；手术治疗的复发风险为 50%。重复 IPAA 是最好的手术方法，复发率为 42.1%。
