[Anorectal Leśniowski-Crohn's disease].
Authors retrospectively reviewed results of surgical treatment of the patients with anorectal Leśniowski-Crohn's (LC) disease, operated in the Department of General and Gastroenterological Surgery in Warsaw.


METHODS
In years 1987-2007 we treated 110 patients with LC disease. The anorectal localization of lesions was noticed in 24 patients (13 women, 11 men, average age of fall--28 year), i.e. 21.8% of all patients. The operations performed in other hospitals were taken into account. Results were compared with literature data.


RESULTS
Anorectal lesions were the first signs of LC disease in 16/110 patients (14.5%), and there were most often: perianal fistulas (multiple) in 12, perianal abscesses in 2, and rectovaginal fistula in 2 patients. In the remaining 8 patients (7.3%), anorectal lesions emerged in later period of the disease, formerly placed in other part of digestive tract. The primary local surgical treatment (incision/excision offistulas, abscess drainage) was performed in 20/24 patients. Most frequent indications were: perianal fistulas--13, perianal abscesses--6, and rectovaginal fistula--1. Primary abdominal operations were performed in 4/24 patients: Hartman procedure in 2 patients with rectovaginal fistulas and in other 2 patients with severe colitis--subtotal colectomy and restorative proctocolectomy. The follow-up in 23/24 patients exceeded 5 years, only in 1 patient was 4 years. The surgical recurrences were noticed in 19/24 (79.1%) patients. Recurrences of fistulas were noticed in 11 patients, in addiction in 5 patients we noticed anal stenosis, in 3 rectal/sigmoidal stenosis and in 3 proctitis of the remaining rectal stump. Surgical recurrences of LC disease after 5, 10 and 15 years of observation were 18/23--78.2%, 14/15-93.3%, and 7/7--100% respectively. Two patients (8.3%) died from severe general complications of the disease. The primary local surgical treatment was sufficient only in 2 patients. In 18/22 patients 28 abdominal operations were carried out in later period of the disease. In all 24 patients we performed 46 extended abdominal operations. In result of them 13/24 patients have definitive and 1 temporary stoma.


CONCLUSIONS
1. Surgical treatment of anorectal LC disease should be sparing and performed in the proper time. 2. Surgical treatment of anorectal LC disease is difficult and should be carried out in reference centers. 3. Anorectal LC disease has poor prognosis in terms of fecal and gas continence and creates the risk of proctectomy in up to 20% of cases.
Bielecki
Krzysztof
K
Z Kliniki Chirurgii Ogólnej i Przewodu Pokarmowego, Centrum Medycznego Kształcenia Podyplomowego w Warszawie.
Baczuk
Lech
L
D000038:Abscess / Q000209:etiology / Q000601:surgery*; D000328:Adult; D000368:Aged; D001004:Anus Diseases / Q000209:etiology / Q000601:surgery*; D003424:Crohn Disease / Q000150:complications / Q000601:surgery*; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011044:Poland; D016737:Proctocolectomy, Restorative; D012002:Rectal Diseases / Q000209:etiology / Q000601:surgery*; D012006:Rectovaginal Fistula / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome