Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt.
Tech Coloproctol. 2023 Dec 11;28(1):7. doi: 10.1007/s10151-023-02880-5.
First described by Parks and Nicholls in 1978, the ileal pouch-anal anastomosis (IPAA) has revolutionized the treatment of mucosal ulcerative colitis (MUC) and familial adenomatous polyposis (FAP). IPAA is fraught with complications, one of which is pouch-vaginal fistulas (PVF), a rare but challenging complication noted in 3.9-15% of female patients. Surgical treatment success approximates 50%. Gracilis muscle interposition (GMI) is a promising technique that has shown good results with other types of perineal fistulas. We present the results from our institution and a comprehensive literature review.
A retrospective observational study including all patients with a PVF treated with GMI at our institution from December 2018-January 2000. Primary outcome was complete healing after ileostomy closure.
Nine patients were included. Eight of nine IPAAs (88.9%) were performed for MUC, and one for FAP. A subsequent diagnosis of Crohn's disease was made in five patients. Initial success occurred in two patients (22.2%), one patient was lost to follow-up and seven patients, after further procedures, ultimately achieved healing (77.8%). Four of five patients with Crohn's achieved complete healing (80%).
Surgical healing rates quoted in the literature for PVFs are approximately 50%. The initial healing rate was 22.2% and increased to 77.8% after subsequent surgeries, while it was 80% in patients with Crohn's disease. Given this, gracilis muscle interposition may have a role in the treatment of pouch-vaginal fistulas.
1978 年由 Parks 和 Nicholls 首次描述，回肠储袋肛管吻合术（IPAA）彻底改变了对溃疡性结肠炎（UC）和家族性腺瘤性息肉病（FAP）的治疗。IPAA 并发症很多，其中之一是储袋阴道瘘（PVF），在 3.9-15%的女性患者中会出现这种罕见但具有挑战性的并发症。手术治疗成功率约为 50%。股薄肌间置术（GMI）是一种有前途的技术，在治疗其他类型的会阴瘘方面已取得良好效果。我们展示了来自我们机构的结果和全面的文献复习。
对 2018 年 12 月至 2000 年 1 月在我院接受 GMI 治疗的所有 PVF 患者进行回顾性观察研究。主要结局是在回肠造口关闭后完全愈合。
共纳入 9 例患者。9 例 IPAA 中有 8 例（88.9%）为 UC 而进行，1 例为 FAP。5 例患者随后诊断为克罗恩病。2 例患者（22.2%）初始成功，1 例失访，7 例患者经进一步治疗后最终愈合（77.8%）。5 例克罗恩病患者中有 4 例完全愈合（80%）。
文献中报道的 PVF 的手术愈合率约为 50%。初始愈合率为 22.2%，经进一步手术增加至 77.8%，而克罗恩病患者为 80%。鉴于此，股薄肌间置术可能在治疗储袋阴道瘘中具有一定作用。
