Management and treatment outcome of pouch-vaginal XXXX following restorative proctocolectomy.

@entity1 @entity12478 @entity31 @entity530 @entity1960 @entity292 @entity1412 @entity30
PURPOSE: The purpose of the study was to evaluate the outcome of surgical management of pouch-vaginal @entity292 in females who had undergone restorative proctocolectomy. METHODS: This study was designed as a retrospective chart review of females treated for pouch-vaginal @entity292 from 1983 to 2000. All @entity1 were followed up using our prospective pouch registry, with additional data collected by interview or mailed questionnaire. RESULTS: Sixty females were identified (mean age, 33.3 +/- 1.3 years), of whom 33 had their initial restorative proctocolectomy done at our institution. Preoperative diagnosis was @entity31 (88 percent), indeterminate @entity1960 (10 percent), and @entity1412 (2 percent). Average time to @entity12478 following restorative proctocolectomy was 21 months (range, 1-132 months). Postoperative @entity530 had occurred in 17 (28 percent) @entity1 . Primary treatment modalities included the following: local repairs (n = 46, 77 percent), the majority of which were ileal advancement flaps; redo restorative proctocolectomy (n = 6, 10 percent); and pouch excision (n = 5, 8 percent). Initial healing was achieved in 20 @entity1 . An additional 11 @entity1 with recurrences healed after repeat procedures. The overall healing rate was 52 percent at 49.4 +/- 3.8 months follow-up. Pouch failure was the eventual outcome in 13 (22 percent) @entity1 and 16 (27 percent) @entity1 had persistent @entity12478 . A delayed diagnosis of @entity30 was made in 24 @entity1 . @entity30 @entity1 had lower success rates following ileal advancement flaps compared with the non-Crohn's group (25 vs. 48 percent, respectively), much lower overall healing rates of their pouch-vaginal @entity292 (17 vs. 75 percent, respectively), and a higher incidence of pouch failure (33 vs. 14 percent, respectively). CONCLUSION: Pouch-vaginal @entity292 are a difficult problem in females following restorative proctocolectomy. However, local repair can be successful with good functional outcomes. Redo restorative proctocolectomy may also achieve healing if local repairs are not possible or have failed. A delayed diagnosis of @entity30 results in worse treatment outcome and higher pouch failure rates.
