TOTAL COLECTOMY AND ILEORECTAL ANASTOMOSI S IN CROHNS COLITIS - FUNCTIONAL RESULTS AND RECURRENCE RATE (83 CASES)

Eighty-three consecutive patients (38 men, 45 women) underwent colecto my and ileorectal anastomosis (IRA) for Crohn's colitis between 1960 a nd 1988. The mean age at the time of IRA was 28.5 years after a mean i nterval of four years from diagnosis. At the time of IRA, 31 patients had proctitis, while 25 had perianal disease. Two patients died postop eratively. Postoperative complications appeared in 21 cases (25.3 %) i ncluding 7 anastomotic leaks (13.2 %). Leakage did not imply IRA compr omise and the diverting ileostomy did not decrease the risk of preserv ation of the ileorectal anastomosis. With a mean follow-up of 8 years after IRA, among the 81 surviving patients, it was necessary to retain the stomy in five, 24 required exclusion or excision of their IRA (10 defunctioning ileostomies, 14 proctectomies) and 52 still had a funct ioning IRA at follow-up (64.2 %). Among the 43 recurrences (53 %), 21 underwent reoperation. The mean interval between IRA and recurrence wa s 2.2 years. The cumulative rate of recurrence reached 47 % at 5 years and 57 % at 10 years. Fifty percent of the patients still had a funct ioning IRA and were satisfied. Preoperative ileal lesions affected the functional results of the IRA and the recurrence rate. Development of ileal rectal or anal disease after IRA significantly increased the ri sk of exclusion of the rectum but did not require suppression of anal function. Patients under 30 years of age or patients suffering for mor e than 5 years had poorer functional results and more frequent reopera tions at 5 years. Rectal preservation after IRA may be proposed with s uccess to patients with a healthy rectum or with minimal or moderate p roctitis, even if there is perianal disease that could be safely treat ed before IRA. In this last setting, the patient has to be informed of the risk of rectal preservation and the possible risk of requiring ul terior proctectomy.