title: Long-term results of ileal pouch-anal anastomosis for colorectal Crohn's disease.
abstract: 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.
authors.affiliation: Department of Surgery, Lariboisière Hospital, Paris, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Regimbeau
authors.forename: Y
authors.initials: Y
authors.lastname: Panis
authors.forename: M
authors.initials: M
authors.lastname: Pocard
authors.forename: Y
authors.initials: Y
authors.lastname: Bouhnik
authors.forename: A
authors.initials: A
authors.lastname: Lavergne-Slove
authors.forename: P
authors.initials: P
authors.lastname: Rufat
authors.forename: C
authors.initials: C
authors.lastname: Matuchansky
authors.forename: P
authors.initials: P
authors.lastname: Valleur
mesh_terms: 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