Long-term results of ileal pouch-anal anastomosis for colorectal Crohn's disease.
BACKGROUND
The aim of this study is to report ten-year results of ileal pouch-anal anastomosis in selected patients with colorectal Crohn's disease for whom coloproctectomy and definitive end ileostomy was the only alternative.


METHODS
41 patients (22 females/19 males) with a mean age of 36 +/- 13 (range, 16-72) years underwent ileal pouch-anal anastomosis for colorectal Crohn's disease between 1985 to 1998. None had past or present history of anal manifestations or evidence of small-bowel involvement. Diagnosis of Crohn's disease was established preoperatively in 26 patients, on the resected specimen after ileal pouch-anal anastomosis, or after occurrence of Crohn's disease-related complication in 15 patients.


RESULTS
Follow-up was 113 +/- 37 months, (18-174) 20 patients having been followed for more than 10 years. There was no postoperative death. Eleven (27 percent) patients experienced Crohn's disease-related complications, 47 +/- 34 months (8-101) after ileal pouch-anal anastomosis: 2 had persistent anal ulcerations with pouchitis and granulomas on pouch biopsy and were treated medically; 2 experienced extrasphincteric abscesses and 7 presented pouch-perineal fistulas which were treated surgically. Among them, 3 patients with persistent perineal fistula despite surgery required definitive end-ileostomy. Of the 20 patients followed for more than 10 years, 7 (35 percent) experienced Crohn's disease-related complications which required pouch excision in 2 (10 percent).


CONCLUSIONS
Ten years after ileal pouch-anal anastomosis for colorectal Crohn's disease, rates of Crohn's disease-related complications and pouch excision were 35 and 10 percent, respectively. These good long-term results justify for us to propose ileal pouch-anal anastomosis in selected patients with colorectal Crohn's disease (i.e., no past or present history of anal manifestations and no evidence of small-bowel involvement) for whom the only alternative is definitive end ileostomy.
Regimbeau
J M
JM
Department of Surgery, Lariboisière Hospital, Paris, France.
Panis
Y
Y
Pocard
M
M
Bouhnik
Y
Y
Lavergne-Slove
A
A
Rufat
P
P
Matuchansky
C
C
Valleur
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006099:Granuloma; D006801:Humans; D007081:Ileostomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019449:Pouchitis; D016737:Proctocolectomy, Restorative; D012003:Rectal Fistula; D012008:Recurrence; D016896:Treatment Outcome; D014456:Ulcer