Long-term results of ileal pouch-anal anastomosis in patients with Crohn's disease.
OBJECTIVE
Ileal pouch-anal anastomosis (IPAA) is the surgical treatment of choice for most patients with chronic ulcerative colitis. Crohn's disease is, however, a contraindication. Because distinction between UC and Crohn's disease can be difficult, some patients with Crohn's disease inadvertently undergo IPAA. The aim of this study was to determine the long-term outcome of patients with Crohn's disease who have undergone IPAA.


METHODS
A total of 37 patients (20 men) were studied. Each had undergone mucosectomy with handsewn IPAA (J-pouch, n = 35; S-pouch, n = 1; W-pouch, n = 1). Histologic examination of the resected specimen at time of IPAA showed features of ulcerative colitiis (n = 22), indeterminate colitis (n = 9), or Crohn's disease (n = 6). The stoma was closed in all patients.


RESULTS
A total of 11 of 37 patients developed complex fistulas (pouch-cutaneous (n = 6), pouch-vaginal (n = 4), or pouch-vesical (n = 1). Crohn's disease has recurred in the pouch (n = 20), anal canal (n = 4), pouch and anal canal (n = 10), and elsewhere (n = 3). After ten years (range, 3-14), the pouch remains in situ in 20 patients in whom frequency of bowel movement is seven times (3-10)/24 hours, in situ but defunctioned in seven patients, and excised in ten patients (failure rate, 45 percent).


CONCLUSIONS
Inadvertent IPAA for Crohn's disease is associated with a high rate of failure (45 percent) but an acceptable long-term functional result if the pouch can be kept in situ.
Sagar
P M
PM
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Dozois
R R
RR
Wolff
B G
BG
D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000601:surgery; D000075202:Contraindications; D003424:Crohn Disease / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D016737:Proctocolectomy, Restorative; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure