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Background:Chronic sinus is a form of anastomotic leak that occurs in patients undergoing IPAA as a blind-ending track. The disease course of a sinus is poorly defined and its management can be challenging.Methods:Patients with chronic sinus were identified from a prospectively-maintained pelvic pouch database from 1997 to 2009. Patients with Crohn's disease of the pouch were excluded. Data pertaining to diagnostic modality, symptom, management, and outcomes were collected by chart review. Results:57 patients(66.1% male) were identified. Mean age at pouch surgery was 40±12.2 years. While 37 patients with chronic sinus underwent 2 or 3-stage primary pouch construction, 20 developed a chronic sinus after redo pouch. 33(57.9%) patients had a previous anastomotic leak or pelvic abscess. Initial diagnostic modalities were endoscopy(57.9%), gastrografin enema(33.3%), and exam under anesthesia(8.7%). MRI was used in 10 patients for further evaluation. 27 patients had sinus before LI closure with 21 having delayed ileostomy closure (median time to closure 197 days, range 119-756). The management of these patients included observation, drainage, unroofing, proximal diversion, and pouch excision. In total 40(70.2%) patients had complete healing of the sinus, 15 (26.3%) had pouch failure. Pouch failure rate was similar between patients who developed sinus before and after ileostomy closure(8/27 vs.7/30,p=0.59). For patients with sinus before ileostomy closure, pouch failure rate was significantly higher in patients without delayed ileostomy closure compared to patients with delayed closure (5/21 vs. 3/4,p=0.047). 30 had sinus after LI closure and 21 were symptomatic including diarrhea(n=12), anal pain(n=3), urgency(n=3), drainage(n=2), and fever(n=1). Pouch failure for the symptomatic patients was high (6/21: 28.6%).Conclusion:A chronic sinus after IPAA may be associated with pouch failure. Better management of the sinus before ileostomy closure may improve pouch retention.