A team from France investigated the long-term outcome of ileal pouch-anal anastomosis in patients with colorectal Crohn's disease.
41 patients (22 females), with a mean age of 36 (range, 16-72) years, underwent ileal pouch-anal anastomosis for Crohn's disease, between 1985 and 1998. The only alternative for these patients was coloproctectomy and definitive end ileostomy.
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. In 15 patients, it was diagnosed after occurrence of Crohn's disease-related complication.
Median length of follow-up was 113 months; 20 patients were followed for more than 10 years.
|Complication rates, 10 years after iIeal pouch-anal anastomosis:|
Crohn's disease-related complications: 35%
Pouch excision: 10%
|Dis Colon Rectum|
There was no postoperative death.
11 (27%) patients were found to experience Crohn's disease-related complications, a mean of 47 months 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.
The researchers found that, of the 20 patients followed for more than 10 years, 7 (35%) experienced Crohn's disease-related complications which required pouch excision in 2 (10%).
Dr J. M. Regimbeau, of the Lariboisière Hospital, Paris, concluded on behalf of the group, "These good long-term results justify for us to propose ileal pouch-anal anastomosis in selected patients with colorectal Crohn's disease, for which the only alternative is definitive end ileostomy. Such patients should have no past or present history of anal manifestations and no evidence of small-bowel involvement in their disease."