Introduction: Pouch-related fistula occurs in 5-10 per cent of patients after restorative proctocolectomy. The present study identified risk factors associated with the development of such fistulas. Methods: Data on preoperative and postoperative risk factors were recorded from 1965 patients who underwent restorative proctocolectomy in a single tertiary centre between 1983 and 2001. Cox regression analysis was used to identify independent predictors of pouch-perineal, pouch-abdominal wall and pouch-vaginal fistula during follow-up. Results: Median patient follow-up was 4-1 (range 0-19) years. By 15 years' follow-up, pouch-vaginal fistulas had occurred in 44 women (5-2 per cent). The prevalence of ileal pouch-perineal and pouch-abdominal wall fistula was 3-6 per cent (70 patients) and 1-5 per cent (30 patients) respectively. Independent predictors of pouch-related fistula identified by multivariate analysis were diagnosis of indeterminate colitis or Crohn's disease (hazard ratio (HR) 1-28 (95 percent confidence interval (c.i.) 1-00 to 1-65) and 1-73 (95 percent c.i. 1-07 to 3-48) respectively versus ulcerative colitis or familial adenomatous polyposis), previous anal pathology (HR 3-43 (95 per cent c.i. 2-43 to 4-84) and 4-02 (95 per cent c.i. 1-27 to 12-77) respectively for perineal abscess and fistula in ano versus no previous anal pathology), abnormal anal manometry (HR 4-29 (95 per cent c.i. 2-33 to 7-91)), patient sex (HR 0-74 (95 per cent c.i. 0-58 to 0-95) for men versus women) and pelvic sepsis (HR 3-79 (95 per cent c.i. 2-48 to 5-79)). Conclusion: This study suggests that Crohn's disease and the clinical signs that favour the diagnosis of Crohn's disease may contribute to the development of pouch-related fistula.
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