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P456. Late perianal fistulas after IPAA

T. Emmanouil1, S. Gavriel2, A. Tachtaras3, N. Giannoulakos3, V. Maniatis3, S. Baratsis2, 1Iaso General, Gastroenterology, Athens, Greece, 2Iaso General, Surgery, Athens, Greece, 3Iaso General, Radiology, Athens, Greece

Background

Total proctocolectomy with ileoanal-pouch anastomosis (IPAA) is considered to be the treatment of choice in patients with familial adenomatous polyposis or in patients with ulcerative colitis (UC) unresponsive to conservative therapy or when they present with high grade dysplasia. One of the most common post-op late complications is the development of perianal fistulas.

Methods

We present our experience on the treatment of 18 patients with IPAA who developed latent perianal fistulas over the last 3 years. From the total number of patients under inspection 15 had UC and 3 had FAP. They were all investigated with pouchoscopy, MRI and endorectal-US. Simple fistulas were treated with seton placement and/or fistulotomy. The complicated ones were treated with advancement flap or temporary ileostomy.

Results

In 3 out of 15 patients with initial diagnosis of UC it was proved to be Crohn's disease and they were treated successfully with biologic agents and preservation of the pouch. In 15 patients with UC or FAP they ended up with spontaneous closure of the fistulae over a period of 6–15 months post surgery with no need of other medication. No patient underwent remodeling of the pouch and all report satisfactory function of defecation.

Conclusion

Late development of perianal fistulas in patients with IPAA for UC needs further investigation for the exclusion of Crohn's disease which could alter the mode of treatment. During the surgical treatment of the fistulas it is needed high attention for avoidance of trauma in the sphincteric mechanism which could lead to deteriorate results of the type of permanent ileostomy.