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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Deutsch AA, McLeod RS, Cullen J, Cohen Z. Results of the pelvic-pouch procedure in patients with Crohn's disease. Dis Colon Rectum 1991;34:475–7.
Scammell BE, Andrews H, Allan RN, Alexander-Williams J, Keighley MR. Results of proctocolectomy for Crohn's disease. Br J Surg 1987;74:671–4.
Grobler SP, Hosie KB, Affie E, Thompson H, Keighley MR. Outcome of restorative proctocolectomy when the diagnosis is suggestive of Crohn's disease. Gut 1993;34:1384–8.
Hyman NH, Fazio VW, Tukson WB, Lavery IC. Consequences of ileal pouch-anal anastomosis for Crohn's colitis. Dis Colon Rectum 1991;34:653–7.
Koltun WA, Schoetz DJ Jr, Roberts PL, Murray JJ, Coller JA, Veidenheimer MC. Indeterminate colitis predisposes to perineal complications after ileal pouch-anal anastomosis. Dis Colon Rectum 1991;34:857–60.
Pezim ME, Pemberton JH, Beart RW,et al. Outcome of “indeterminant” colitis following ileal pouch-anal anastomosis. Dis Colon Rectum 1989;32:653–8.
Panis Y, Poupard B, Nemeth J, Lavergne A, Hautefeuille P, Valleur P. Ileal pouch-anal anastomosis for Crohn's disease. Lancet 1996;347:854–7.
Lennard-Jones J. Classification of inflammatory bowel disease. Scand J Gastroenterol 1989;170:2–6.
Bernell O, Lapidus A, Hellers G. Risk factors for surgery and postoperative recurrence in Crohn's disease. Ann Surg 2000;231:38–45.
Panis Y, Bonhomme N, Hautefeuille P, Valleur P. Ileal pouch-anal anastomosis with mesorectal excision for rectal cancer complicating familial adenomatous polyposis. Eur J Surg 1996;162:817–21.
Berrebi W, Chaussade S, Bruhl AL,et al. Treatment of Crohn's disease recurrence after ileoanal anastomosis by azathioprine. Dig Dis Sci 1993;38:1558–60.
Benoist S, Panis Y, Berdah S, Hautefeuille P, Valleur P. New treatment for ileal pouch-anal or coloanal anastomotic stenosis. Dis Colon Rectum 1998;41:935–7.
Fazio VW, Ziv Y, Church JM,et al. Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg 1995;222:120–7.
Sagar PM, Dozois RR, Wolff BG. Long-term results of ileal pouch-anal anastomosis in patients with Crohn's disease. Dis Colon Rectum 1996;39:893–8.
Gorenstein L, Boyd JB, Ross TM. Gracilis muscle repair of rectovaginal fistula after restorative proctocolectomy: report of two cases. Dis Colon Rectum 1988;31:730–4.
Fazio VW, Tjandra JJ. Pouch advancement and neoileoanal anastomosis for anastomotic stricture and anovaginal fistula complicating restorative proctocolectomy. Br J Surg 1992;79:694–6.
Ozuner G, Hull T, Lee P, Fazio VW. What happens to a pelvic pouch when fistula develops? Dis Colon Rectum 1997;40:543–7.
Ricart E, Panaccione R, Loftus EV, Tremaine WJ, Sandborn WJ. Successful management of Crohn's disease of the ileoanal pouch with infliximab. Gastroenterology 1999;117:429–32.
Phillips RS. Ileal pouch-anal anastomosis for Crohn's disease. Gut 1998;43:303–4.
Author information
Authors and Affiliations
About this article
Cite this article
Regimbeau, J.M., Panis, Y., Pocard, M. et al. Long-term results of ileal pouch-anal anastomosis for colorectal Crohn's disease. Dis Colon Rectum 44, 769–776 (2001). https://doi.org/10.1007/BF02234693
Issue Date:
DOI: https://doi.org/10.1007/BF02234693