COMPLICATIONS AND POSTOPERATIVE COURSE AF TER PROCTECTOMY FOR CROHNS-DISEASE

The decision to perform protectomy must be considered very seriously i n the course of Crohn's disease. The objectives of this study were to evaluate the consequences of this procedure : healing, sexual disorder s, quality of life and the subsequent course of the disease. From 1981 to 1993, we performed 24 proctectomies: 15 females, 9 males, mean age : 39 years (18-76), mean preoperating time: 9+/-4 years. Rectal and an operineal lesions were always accompanied by pancolitis; ileal involve ment was observed in 11 cases (45%) at the time of diagnosis of Crohn' s disease, and in 4 cases at the time of proctectomy. Proctectomy was performed after a period of rectal exclusion in 19 patients, while the rectum was not isolated for 5 others, including 2 patients after tota l colectomy. The indication for surgery was based on the coexistence o f a microrectum (n=16), anal stenosis (n=15), rectovaginal or complex fistulas (n=15). Technical features were: close rectal dissection (n=1 9), levator muscle preservation (n=7), wall effraction (n=8), primary closure (n=6) or perineal wound packing (n=18). Mean follow-up: 44+/-2 4 months, statistical analysis: Fisher's test, Wilcoxon's test and Kap lan-Meier method. No perioperative deaths were observed. An intraperit oneal collection required drainage. Mean hospital stay was 21 days. Se xual complications were: dyspareunia (n=3), ejaculation failure (n=1), not correlated to the type of dissection. Perineal wound healing was considered to be normal when. it took less than 6 months (n=14). The h ealing time was 5 months after primary closure versus 9 months after p acking, p=0.0383. Young age, female sex and rectal wall effraction see med to delay hearing, but with no significant difference, p>0.05. Mean ileostomy drainage was 650+/-200 cc per day; 19 patients (79%) were s atisfied with their stomy set and their quality of life. An ileal recu rrence was reported in 3 cases (12.5%), with a mean recurrence time of 52+/-6 months. Ileal involvement was observed at the onset of the dis ease in these 3 cases. Among the cases of recurrence, only I patient h ad specific small bowel lesions at the time of proctectomy. Statistica l analysis of the curver suggests that the risk of recurrence is incre ased when ileal involvement is present at some time during the course of the disease (p=0.02). This study confirms the frequency of healing complications and the rarity of sexual consequences. Our recurrence ra te is similar to that of other studies. It is lower than small bowel r ecurrences after ileorectal anastomoses. The risk of recurrence seems to be enhanced by previous ileal involvement.