Bronze Sergio, Kayal Maia, Estevinho Maria Manuela, Hahn Sue, Khaitov Sergey, Colombel Jean-Frederic, Wong Serre-Yu
Gastroenterology and Hepatology Department, Unidade Local de Saúde de Santa Maria, Lisbon, Portugal.
The Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Inflamm Bowel Dis. 2025 Jun 13;31(6):1716-1722. doi: 10.1093/ibd/izae221.
Ileoanal pouch-related fistula (IAPRF) is a possible complication after ileal pouch-anal anastomosis that significantly impacts pouch prognosis and the patient's quality of life. This study aimed to perform a comprehensive narrative review to better classify the epidemiology, risk factors, etiology, management, and outcomes of IAPRF, and to propose an algorithm for its systematic classification. Ten studies comprising 664 patients with IAPRF were identified, with a prevalence ranging from 4% to 45%. The reported fistula types were as follows: pouch-vaginal (n = 236, 35.5%), perineal (n = 139, 21%), enterocutaneous (n = 54, 8%), pouch-anal (n = 53, 8%), presacral (n = 18, 2%), and anastomotic (n = 15, 2%). Postsurgical pelvic sepsis occurred in 21%-37.2% of patients. Twenty additional studies regarding fistula classification divided them according to onset time and etiology, defining 5 categories: anastomotic-related, technical aspects of the surgery, Crohn's disease-like pouch inflammation, cryptoglandular, and malignancy. Pouch excision was reported in up to 70% of patients. Fistulas associated with anastomotic complications, technical surgical issues, and cryptoglandular fistulas warrant surgical management. On the other hand, fistulas associated with inflammation are preferentially managed with biologics or small molecules.
回肠肛管袋相关瘘（IAPRF）是回肠袋肛管吻合术后可能出现的并发症，会显著影响袋的预后和患者的生活质量。本研究旨在进行全面的叙述性综述，以更好地对IAPRF的流行病学、危险因素、病因、管理和结局进行分类，并提出一种系统分类算法。共纳入10项研究，涉及664例IAPRF患者，患病率在4%至45%之间。报告的瘘类型如下：袋-阴道瘘（n = 236，35.5%）、会阴瘘（n = 139，21%）、肠皮肤瘘（n = 54，8%）、袋-肛管瘘（n = 53，8%）、骶前瘘（n = 18，2%）和吻合口瘘（n = 15，2%）。21%至37.2%的患者术后发生盆腔脓毒症。另外20项关于瘘分类的研究根据发病时间和病因将其分为5类：吻合口相关、手术技术方面、克罗恩病样袋炎、隐窝腺源性和恶性肿瘤。据报告，高达70%的患者进行了袋切除术。与吻合口并发症、手术技术问题和隐窝腺源性瘘相关的瘘需要手术治疗。另一方面，与炎症相关的瘘优先采用生物制剂或小分子药物治疗。
