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 19 February 2018

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News

Outcomes of restorative proctocolectomy for Crohn's and colitis

Research in the latest issue of Colorectal Disease shows that Crohn's disease and indeterminate colitis favouring Crohn's disease are both associated with high failure rates and postoperative pouch-related fistula rates.

News image

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Professor Nicholls and colleagues from England evaluated the short-term and long-term outcomes of patients undergoing restorative proctocolectomy for Crohn's disease and Indeterminate colitis.

The researchers also aimed to identify factors associated with adverse outcomes.

58 % of patients with Crohn’s disease had a pouch failure
Colorectal Disease

The team conducted a descriptive study with 52 patients with Crohn’s disease or indeterminate colitis.

The patients were included from a total of 1652 patients undergoing primary or salvage restorative proctocolectomy in a single tertiary referral centre between 1978 and 2003.

The researchers’ primary outcomes were ileal pouch failure (excision or indefinite diversion), adverse events and functional outcomes (bowel frequency, urgency and continence).

The investigators found that 26 patients with indeterminate colitis or indeterminate colitis favouring ulcerative colitis (Group 1) had a pouch failure rate of 12 %.

26 patients with Crohn’s disease or indeterminate colitis favouring Crohn’s disease (Group 2) had a pouch failure rate of 58 %.

The researchers reported that pouch salvage surgery was undertaken in 15 patients with a 13 % failure rate.

No significant differences were evident between Crohn’s disease and indeterminate colitis patients with regards to pelvic sepsis, anastomotic stricture, small bowel obstruction or pouchitis.

In addition, the investigators found that the 24 hour bowel frequency was similar between patients with Crohn’s disease or indeterminate colitis to develop a pouch-related fistula.

Faecal urgency, daytime or night time incontinence were also similar between the patients.

Professor Nicholls’ team concludes, “Crohn's disease and to a great extent indeterminate colitis favouring Crohn’s disease are both associated with high failure rates and postoperative pouch-related fistula rates.”

“Despite these problems, functional outcomes for patients with Crohn’s disease or indeterminate colitis were similar.”

Colorectal Dis 2005: 7(3): 218
04 May 2005

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