title: Ileal pouch rectal anastomosis: a viable alternative to permanent ileostomy in Crohn's proctocolitis patients.
abstract: BACKGROUND
  Ileal pouch rectal anastomosis (IPRA) is a possible alternative to permanent ileostomy when a short, normal-appearing rectal stump remains after total colectomy. Its outcomes in Crohn colitis (CC) patients have not been reported.
  
  
  METHODS
  CC patients who underwent IPRA from 1992 to 2004 were identified. Operative and morbidity data were collected. Functional outcomes and quality-of-life (QOL) data were obtained using a mailed questionnaire and compared with matched patients who underwent straight ileorectal anastomosis (SIRA).
  
  
  RESULTS
  Twenty-three CC patients underwent IPRA. Perioperative complications included three pelvic septic fluid collections and five small bowel obstructions or ileus, and were treated nonoperatively. Twenty-two patients were available for longterm followup (median 98 months). Fourteen patients (64%) had disease recurrence. Two (9%) have lost a functioning anastomosis. Nine (41%) required additional operations. Matched SIRA patients had higher level of anastomosis (23.4 +/- 5.5 versus 9.0 +/- 4.1 cm above the dentate line; p < 0.0001). Bowel movement frequency (median 6.5/24 hours in both groups), incontinence, and urgency rates were similar. Nighttime seepage and pad usage were more frequent in IPRA. No differences were found in QOL parameters (Cleveland Global QOL score: 0.78 versus 0.73 [0 = worst, 1 = best], IPRA versus SIRA, respectively; p = 0.31). All patients with a functioning IPRA stated they would have their operation again if needed, and 94% would recommend it to others.
  
  
  CONCLUSIONS
  IPRA offers durable preservation of bowel continuity and good function and QOL in selected CC patients who might otherwise require a permanent ileostomy.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Kariv
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
authors.forename: Scott A
authors.initials: SA
authors.lastname: Strong
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Hammel
authors.forename: Miriam
authors.initials: M
authors.lastname: Preen
authors.forename: Victor W
authors.initials: VW
authors.lastname: Fazio