Total Colectomy for Crohn’s Disease

Rieger, Nicholas; Collopy, Brian T.; Fink, Rok; Woods, Rodney; Keck, James

doi:10.1046/j.1440-1622.1999.01486.x

Cited by 16 publications

(10 citation statements)

References 20 publications

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“…[26][27][28] Variable results have been reported in the literature, 29,30 with recurrence rates as high as 71 percent 24,31 and only 63 percent of patients retaining a functioning anastomosis at ten years follow-up. 32 Other authors have reported more than 50 percent proctectomy rate within ten years from the original operation.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcome of Surgically Treated Crohn's Colitis: A Prospective Study

Fichera

McCormack

Rubin

et al. 2005

Diseases of the Colon &Amp; Rectum

116

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A more aggressive approach should be considered in patients with diffuse and distal Crohn's colitis. Total proctocolectomy in the properly selected patients is associated with low morbidity, lower risk of recurrence, and longer time to recurrence. Patients after total proctocolectomy are more likely to be weaned off all Crohn's-related medications. Long-term rate of permanent fecal diversion is significantly higher in patients with distal disease.

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Section: Discussionmentioning

confidence: 99%

Long-Term Outcome of Surgically Treated Crohn's Colitis: A Prospective Study

Fichera

McCormack

Rubin

et al. 2005

Diseases of the Colon &Amp; Rectum

116

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“…Rieger et al 26 found that 47 per cent of patients with Crohn's disease required an ileostomy after IRA. Chevalier et al 27 reported that only 51 per cent of their patients with Crohn's disease retained a functioning anastomosis.…”

Section: Functional Outcomementioning

confidence: 99%

Mortality, morbidity and functional outcome after ileorectal anastomosis

Elton

Makin

Hitos

et al. 2003

Journal of British Surgery

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“…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]. …”

Section: Discussionmentioning

confidence: 57%

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

Sciaudone

Pellino²,

Riegler³

et al. 2011

Eur Surg Res

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The aim of this intervention study is to determine whether long-term infliximab therapy can decrease the proctectomy rate in patients with failed total colectomy and ileorectal anastomosis (IRA) for Crohn’s disease (CD). Twelve patients (5 females) – with a median age of 36.6 years (range 18–56 years), previously treated with IRA (5 in our institution and 7 referred) for colorectal and perianal CD (median Crohn’s Disease Activity Index 334.5, range 220–426), with rectal disease recurrence requiring proctectomy, no responders to conventional therapy but infliximab-naïve – were treated with infliximab infusions (Remicade™ 5 mg/kg at 0, 2, 6 weeks and then every 8 weeks) to avoid proctectomy. The main outcome measures consisted of IRA preservation and bowel function at study end. Mortality and major adverse reactions have not been observed. At the time of the median follow-up (57.4 months, range 36–92), the rectum was preserved in 10 patients (83.3%). One patient underwent proctectomy 6 weeks after the beginning of the treatment for unresponsiveness to drugs and another after 26 weeks for rectal stenosis. Anorectal function (maximum tolerated volume: 239 ± 43 vs. 294 ± 36 ml) and quality of life (Inflammatory Bowel Disease Questionnaire score 89.2 ± 20.6 vs. 173.8 ± 31.9) improved, and the Wexner Continence score (4.4 ± 2.4 vs. 1.7 ± 1.0) and daily defecations (5.2 ± 1.03 vs. 2.7 ± 1.05) decreased in 10 patients. Our results, although preliminary, are encouraging and seem to justify a less aggressive approach in patients with rectal and perianal recurrence after IRA for CD.

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Total Colectomy for Crohn’s Disease

Abstract: A permanent ileostomy after total colectomy for Crohn's disease is common and significantly more likely with rectal involvement.

Cited by 16 publications

References 20 publications

Long-Term Outcome of Surgically Treated Crohn's Colitis: A Prospective Study

Long-Term Outcome of Surgically Treated Crohn's Colitis: A Prospective Study

Mortality, morbidity and functional outcome after ileorectal anastomosis

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

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