What question did this study set out to answer?

This research aims to investigate the cumulative incidence of ileal pouch-associated fistulas and their effect on IPAA outcomes.

February 16, 2026Open Access

Poster Session II - A257 THE IMPACT OF FISTULAS IN PATIENTS WITH ILEAL POUCH ANAL ANASTOMOSIS: A COMPARATIVE COHORT STUDY

Key Points

This research aims to investigate the cumulative incidence of ileal pouch-associated fistulas and their effect on IPAA outcomes.
Retrospective cohort study of adults with inflammatory bowel disease undergoing IPAA
Fistulas classified and incidence estimated using Kaplan-Meier methods
Cox proportional hazards models assessed association of fistulas with pouch failure, adjusted for various factors.
Cumulative risk of ileal pouch-associated fistulas at 1, 5, 10, and 20 years was 3.1%, 8.4%, 13.8%, and 29.8% respectively
Fistulas were strongly associated with pouch failure (adjusted hazard ratio 7.1)
70% of patients received advanced therapy post-fistula diagnosis, mainly anti-TNF therapy
Fistula remission rates after advanced therapy were 37.5% at 3 months and 41.7% at 12 months.

Abstract

Abstract Background Ileal pouch-anal anastomosis (IPAA) is the standard surgical approach for ulcerative colitis. Complications associated with IPAA, including pouchitis, strictures, and fistulas pose major risks for morbidity, diversion, and IPAA failure. However, the impact of fistulas on IPAA outcomes are poorly understood. Aims To determine the cumulative incidence of IPAA associated fistulas (IAFs), and to determine if they are associated with adverse IPAA outcomes. Methods We performed a retrospective cohort study of adults with inflammatory bowel disease (IBD) who underwent IPAA and were followed at The Ottawa Hospital (2005-2024). Fistulas were classified as perianal, rectovaginal, or pouch-body, and as early (6 months) or late (6 months) post-ileostomy closure. Kaplan-Meier methods estimated cumulative incidence of fistula formation, fecal diversion, and pouch excision. Cox proportional hazards models adjusted for age, sex, luminal Crohn’s-like phenotype, and rectal stricture to evaluate the association between IAFs and pouch failure, a composite of fecal diversion or pouch excision. Fistula remission was defined clinically as absence of drainage without diversion. Results We identified 332 patients with IPAA: 48.8% female, mean age 33 ± 13 years. The cumulative risk of developing a IAF was 3.1%, 8.4%, 13.8%, and 29.8% at 1, 5, 10, and 20 years, respectively (Figure 1). The types of fistulas included perianal (55.8%), rectovaginal (37.7%), and pouch-body (6.5%). After a mean follow-up of 15.5 ± 9.9 years, PAFs were strongly associated with pouch failure (aHR, 7.1; 95% CI 3.3-15.5) including fecal diversion (aHR, 5.3; 95% CI 2.2-12.5) and pouch excision (aHR, 9.9; 95% CI 3.2-31.0). Following fistula diagnosis, 70% received an advanced therapy, most often anti-TNF therapy (87%). Fistula remission without fecal diversion occurred in 37.5% at 3 months, 39.6% at 6 months, and 41.7% at 12 months after first-line advanced therapy; 27.1% remained in remission at final follow-up. Conclusions In this single center study, we found that 14% of patients developed an IAF within 10 years and that fistulas were significantly associated with IPAA failure. These findings highlight the need for early detection, multidisciplinary care, and development of targeted therapies for fistulizing pouch disease. Funding Agencies None

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Cite This Study

Sayed et al. (Sun,) studied this question.

synapsesocial.com/papers/6992b3939b75e639e9b085bd https://doi.org/https://doi.org/10.1093/jcag/gwaf042.256

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