Long-term results of ileal pouch-anal anastomosis for colorectal crohn's disease

J. M. Regimbeau, Y. Panis, M. Pocard, Y. Bouhnik, A. Lavergne-Slove, P. Rufat, C. Matuchansky, P. Valleur, S. A. Strong, J. M. Regimbeau, Y. Panis, M. Pocard, Y. Bouhnik, A. Lavergne-Slove, C. Matuchansky, P. Valeur, P. Rufat

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138 Scopus citations

Abstract

INTRODUCTION: 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.

Original languageEnglish (US)
Pages (from-to)769-778
Number of pages10
JournalDiseases of the colon and rectum
Volume44
Issue number6
DOIs
StatePublished - 2001

Keywords

  • Anoperineal Crohn's disease
  • Coloproctectomy
  • Crohn's disease
  • Definitive end ileostomy
  • Ileal pouch-anal anastomosis
  • Long-term results

ASJC Scopus subject areas

  • Gastroenterology

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