The prognosis of ileorectal anastomosis in Crohn's disease

Abstract

A total of 105 patients have been treated with colectomy and ileorectal anastomosis from 1958 to 1978 in Birmingham, England (48) and in Leiden, Netherlands (57). At the end of 1978 the mean follow-up was 7.6 years (6 months-20 years). Mild or moderate degrees of proctitis were not considered as contraindications for ileorectal anastomosis. The presence or absence of ileal disease or perianal disease at the time of ileorectal anastomosis did not effect the long term prognosis but patients with sigmoidoscopic proctitis appeared to fare less well (69 per cent still functioning) than those with an apparently normal rectum (87 per cent). However, no statistical significance was obtained. The risk of reoperation for recurrence of Crohn's disease after ileorectal anastomosis calculated by actuarial methods shows a 50 per cent cumulative reoperation rate after 16-20 years. This result suggests that ileorectal anastomosis is a safe and useful procedure for most patients with Crohn's colitis who did not have severe proctitis.

Infliximab in Drug-Naïve Patients with Failed Ileorectal Anastomosis for Crohn’s Disease: A New Chance for Sparing the Rectum?

“…Many authors reported similar findings, with the rate of proctectomy after IRA ranging between 11 and 32% (table 3) [19,20,21,22,23,24,25]. …”

“…In a study with a mean follow-up of 7.5 years, Buchmann et al [19] showed that 20% of 105 patients with IRA underwent a total proctectomy. Many authors reported similar findings, with the rate of proctectomy after IRA ranging between 11 and 32% (table 3) [19,20,21,22,23,24,25].…”

“…Buchmann et al [19] showed that, except in patients with severe proctitis with rectal strictures, severe perianal disease or incontinence, the presence of rectal, perianal or ileal disease did not modify the prognosis of IRA even when it is performed without a diverting ileostomy. Other authors reported that a protective ileostomy and the presence of perianal disease at the time of colectomy are negative prognostic factors for the fate of the rectum [24].…”

“…Hence, perianal disease and surgical procedures after IRA should not be contraindications to infliximab salvage treatment; however, patients with severe perianal pictures should be informed of a higher failure rate of infliximab treatment in such a condition. We decided not to perform a protective ileostomy before infliximab treatment: first not to delay biological therapy and not to overstress patients who are already candidates for proctectomy, and moreover because of the lack of evidence that it could have offered a clear advantage [19,24]. …”

Surgery for Inflammatory Bowel Diseases

“…In some patients, the recurrence may be confined to the small bowel, so a further resection and anastomosis is possible. Thus, approximately 75% of patients may have a functioning IRA at 5 years and 50% at 10 years [25][26][27][28].…”