LONG-TERM RESULTS OF ILEAL POUCH-ANAL ANASTOMOSIS IN PATIENTS WITH CROHNS-DISEASE

PURPOSE: Ileal pouch-anal anastomosis (IPAA) is the surgical treatment of choice for most patients with chronic ulcerative colitis. Crohn's disease is, however, a contraindication. Because distinction between U C and Crohn's disease can be difficult, some patients with Crohn's dis ease inadvertently undergo IPAA. The aim of this study was to determin e the long-term outcome of patients with Crohn's disease who have unde rgone IPAA. METHODS: A total of 37 patients (20 men) were studied. Eac h had undergone mucosectomy with handsewn IPAA (J-pouch, n = 35; S-pou ch, n = 1; W-pouch, n = 1). Histologic examination of the resected spe cimen at time of IPAA showed features of ulcerative colitis (n = 22), indeterminate colitis (n = 9), or Crohn's disease (n = 6). The stoma w as closed in all patients. RESULTS: A total of 11 of 37 patients devel oped complex fistulas (pouch-cutaneous (n = 6), pouch-vaginal (n = 4), or pouch-vesical (n = 1). Crohn's disease has recurred in the pouch ( n = 20), anal canal (n = 4), pouch and anal canal (n = 10), and elsewh ere (n = 3). After ten years (range, 3-14), the pouch remains in situ in 20 patients in whom frequency of bowel movement is seven times (3-1 0)/24 hours, in situ but defunctioned in seven patients, and excised i n ten patients (failure rate, 45 percent). CONCLUSIONS: Inadvertent IP AA for Crohn's disease is associated with a high rate of failure (45 p ercent) but an acceptable long-term functional result if the pouch can be kept in situ.