Full mucosal proctectomy initiated below the dentate line may prevent the development of a perianal fistula after ileal pouch-anal anastomosis for ulcerative colitis.

Abstract:

BACKGROUND:Long-term functional results of ileal pouch-anal anastomosis (IPAA) with mucosal proctectomy (MP) for ulcerative colitis (UC) are satisfactory but may be compromised by perianal fistulae. METHODS:We analyzed the effect of the level of MP (above or below the dentate line) on the risk of perianal fistulae in 151 patients undergoing IPAA for UC. RESULTS:A postoperative perianal fistula occurred in 12 patients (10 with MP from the level above the dentate line and 2 below). Patients developing perianal fistulae after IPAA were significantly younger at IPAA (23 vs. 32 years, p = 0.015). Age <25 years at UC onset (hazard ratio, HR, 3.5, p = 0.041), age <30 years at IPAA (HR 4.3, p = 0.015) and MP above the dentate line (HR 4.7, p = 0.010) were significant risk factors for perianal fistulae after IPAA. Multivariate analysis showed that age <30 years at IPAA (HR 4.4, p = 0.018) and MP above the dentate line (HR 6.0, p = 0.012) were significant risk factors. CONCLUSION:IPAA with MP below the dentate line for UC might reduce the risk of postoperative perianal fistulae.

journal_name

Dig Surg

journal_title

Digestive surgery

authors

Araki T,Okita Y,Fujikawa H,Inoue Y,Mohri Y,Kusunoki M

doi

10.1159/000351443

subject

Has Abstract

pub_date

2013-01-01 00:00:00

pages

219-24

issue

3

eissn

0253-4886

issn

1421-9883

pii

000351443

journal_volume

30

pub_type

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