Intersphincteric proctectomy with end-colostomy for anorectal Crohn's disease results in early and severe proximal colonic recurrence.
BACKGROUND
Perianal Crohn's disease (CD) represents a more aggressive phenotype of inflammatory bowel disease and often coincides with proctocolitis. This study aims to assess the outcome of patients undergoing proctectomy with end-colostomy.


METHODS
A retrospective outcome analysis of 10 consecutive patients who underwent intersphincteric proctectomy with end-colostomy between February 2007 and May 2011 was performed. All patients suffered from refractory distal and perianal CD. The proximal colon was normal at endoscopy. All data were extracted from a prospectively maintained database. The main outcome parameter was disease recurrence and need for completion colectomy.


RESULTS
Severe and early endoscopic recurrence in the proximal colon occurred in 9/10 patients at a median time interval of 9.5 months (range: 1.9-23.6 months). Despite protracted medical treatment, completion colectomy was necessary in 5 patients. One patient, who underwent a second segmental colectomy with a new end-colostomy, showed again endoscopic recurrence and is currently treated with anti-TNF agents.


CONCLUSIONS
Intersphincteric proctectomy with colostomy seems to be an ineffective surgery for perianal CD with coexisting proctitis and results in a high risk of recurrence of the disease in the remaining colon. Therefore, despite a normal appearance of the proximal colon, a proctocolectomy with end-ileostomy seems to be the surgical approach of choice in these patients.
Department of Abdominal Surgery, University Hospital Gasthuisberg Leuven, Belgium. anthony.debuckvanoverstraeten@uzleuven.be
Anthony
A
de Buck van Overstraeten
Albert M
AM
Wolthuis
Séverine
S
Vermeire
Gert
G
Van Assche
Paul
P
Rutgeerts
Freddy
F
Penninckx
André
A
D'Hoore
D000328:Adult; D003125:Colostomy / Q000009:adverse effects* / Q000379:methods; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011349:Proctitis / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D055815:Young Adult