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Clin Colon Rectal Surg 2022; 35(06): 469-474
DOI: 10.1055/s-0042-1758138
Review Article

Management of Anastomotic Leaks in Ileal Pouch Anal Anastomosis for Ulcerative Colitis

Alex Liu Huang
1   Colon and Rectal Surgery Division, Department of General Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
,
Michael Plietz
1   Colon and Rectal Surgery Division, Department of General Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
,
Alexander J. Greenstein
1   Colon and Rectal Surgery Division, Department of General Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
,
Sergey Khaitov
1   Colon and Rectal Surgery Division, Department of General Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
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Abstract

Anastomotic leaks remain a dreaded complication after ileal pouch anal anastomosis (IPAA). Their impacts can be devastating, ranging from an acute leak leading to postoperative sepsis to chronic leaks and sinus tracts resulting in long-term pouch dysfunction and subsequent pouch failure. The management of acute leaks is intricate. Initial management is important to resolve acute sepsis, but the type of acute intervention impacts long-term pouch function. Aggressive management in the postoperative period, including the use of IV fluids, broad-spectrum antibiotics, and operative interventions may be necessary to preserve pouch structure and function. Early identification and knowledge of the most common areas of leak, such as at the IPAA anastomosis, are important for guiding management. Long-term complications, such as pouch sinuses, pouch-vaginal fistulas, and diminished IPAA function complicate the overall survival and functionality of the pouch. Knowledge and awareness of the identification and management of leaks is crucial for optimizing IPAA success.

Keywords

ileal pouch anal anastomosis - anastomotic leak - pouch-vaginal fistula - Crohn's of the pouch


Publication History

Article published online:
02 November 2022

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