Background and Aims

Pouch sinus may be a serious adverse event in patients undergoing ileal pouch-anal anastomosis. The aim of this study was to compare endoscopic sinusotomy (ESi) and redo pouch surgery in the management of pouch sinus.

Methods

All consecutive ulcerative colitis patients with chronic pouch sinuses treated with ESi versus redo surgery from 2006 to 2016 were identified. The primary outcomes were recurrence-free and surgery-free survivals. The secondary outcome was postprocedural adverse events.

Results

This historical cohort study included 226 patients (ESi, n = 141; redo surgery, n = 85). Complete healing of the sinus was achieved in 75 patients (53.2%) and partial healing in 23 patients (16.3%) with ESi, and an initial complete healing (ie, no anastomotic leak before ileostomy closure) was obtained in 80 patients (94.1%) receiving redo surgery. Sinus recurrence after complete healing was seen in 17 patients (22.7%) treated with ESi and 28 patients (32.9%) treated with surgery (P = .15). Subsequent surgery was needed in 34 patients (24.1%) with ESi therapy and 18 patients (21.2%) with initial redo surgery (P = .70). Kaplan-Meier recurrence-free and surgery-free survivals after initial procedures showed no statistical difference between the 2 groups (P = .42 and P = .65, respectively). The rate of adverse events in the ESi group was significantly lower than that in the surgery group (2.5% vs 43.5%, P < .0001).

Conclusions

Recurrence-free and surgery-free survivals were comparable between patients treated with ESi and redo surgery, whereas pouch redo surgery was found to be associated with a higher immediate complete healing rate yet a higher morbidity.

中文翻译：

---

内窥镜鼻窦切开术与重做术治疗溃疡性结肠炎患者慢性囊吻合窦

背景和目标

在进行回肠囊袋肛门吻合术的患者中，囊袋窦可能是严重的不良事件。这项研究的目的是比较内窥镜鼻窦切开术（ESi）和重做囊袋手术在囊袋窦的处理中。

方法

确定了2006年至2016年间所有连续进行的慢性囊性鼻窦溃疡性结肠炎患者，采用ESi与重做手术相结合的治疗方法。主要结果是无复发和无手术生存。次要结果是手术后不良事件。

结果

这项历史性队列研究包括226例患者（ESi，n = 141；重做手术，n = 85）。ESi的75例患者（53.2％）实现了鼻窦的完全愈合，ESi的23例患者中实现了部分愈合，而80例的患者（904.1％）达到了初始的完全愈合（即在回肠造口术闭合之前没有吻合口漏）。 ）接受重做手术。在用ESi治疗的17例患者（22.7％）和通过手术治疗的28例患者（32.9％）观察到完全愈合后的鼻窦复发（P  = .15）。34例（24.1％）的ESi治疗患者和18例（21.2％）的初次重做手术需要进行后续手术（P  = .70）。初始程序后，Kaplan-Meier的无复发生存率和无手术生存率显示两组之间无统计学差异（P = 0.42和P  = 0.65）。ESi组的不良事件发生率显着低于手术组（2.5％比43.5％，P  <.0001）。

结论

在使用ESi和重做手术的患者中，无复发生存率和无手术生存率相当，而袋装重做手术则具有较高的即时完全治愈率和较高的发病率。