Ileorectal anastomosis in patients with Crohn's disease of the colon.

Abstract

SUMMARY Thirty-seven patients were studied who had an ileorectal anastomosis performed for Crohn's disease of the colon. Twenty-nine were done as a primary procedure and in eight the anastomosis was made after previous total or segmental colectomy. Three There has been much discussion and controversy concerning the practicality of performing an ileorectal anastomosis after colectomy for Crohn's colitis. The surgeon may choose to leave the rectum in situ either because he considers the patient to be a poor surgical risk or because the rectum appears to be normal or near normal at the time of surgery. Total colectomy with ileostomy and mucous fistula is the most frequently performed operation for extensive Crohn's colitis, but it is our contention that either a primary ileorectal anastomosis or an ileorectal anastomosis after a total colectomy and ileostomy is a preferable procedure in selected cases.The purpose of this study was to analyze our results in a group of 37 patients with Crohn's disease of the colon who were treated by colectomy and ileorectal anastomosis so as to have a basis for comparison with the results obtained with colectomy

The prognosis of ileorectal anastomosis in Crohn's disease

“…In our series of 105 patients undergoing a colectomy and ileorectal anastomosis for Crohn's colitis, the success rate was 70 per cent after a mean follow-up time of 7-6 years. This is higher than that of approximately 50 per cent reported by others (6), but below the 80 per cent obtained by Flint et al (2) who used very restricted indications for ileorectal anastomosis.…”

“…COLECTOMY and ileorectal anastomosis has been advocated for selected groups of patients with Crohn's colitis (1,2). This procedure has been used at both the University Hospital, Leiden, Netherlands, and the General Hospital Birmingham, England; early results have already been published (3-5).…”

Total Colectomy for Crohn’s Disease

“…The rate of ileostomy with or without proctectomy after total colectomy in Crohn’s disease has been reported from 26 to 45%. These reports are in patients who mostly had an ileorectal anastomosis 9 –11 , 15 –21 . In the present series the rate of ileostomy was not influenced by having an emergency or an elective operation or the presence of anal disease.…”

“…The mortality and morbidity of total colectomy was high in the present series, but this has been previously noted 10 , 11 . Carcinoma in Crohn’s disease and a defunctioned rectum has been previously reported 12 .…”

Colonic Crohn's disease

“…A number of authors have published their results with total colectomy and ileorectal anastomosis for CD of the large bowel. The average recurrence rate is 57%; 70% of the patients maintain intestinal continuity for more than a decade after their initial resection with anastomosis (Table 2) [16][17][18].…”