Surgical treatment of Crohn's disease of the colon: impact of associated proctitis on the results of ileorectal anastomosis.

Study aim: The purpose of this retrospective study was to compare the morbi dity and long-term outcome of patients undergoing total colectomy and ileor ectal anastomosis (IRA) performed for Crohn's colitis with or without assoc iated proctitis. Patients and methods: Thirty-nine patients with a mean age of 35 years (17- 72 years) underwent total colectomy with IRA. Patients were retrospectively classified into two groups; group 1 (28) without rectal involvement; group 2 (11) with proctitis. Follow-up data were obtained during 1998, by review ing all patients. Mean postoperative follow-up was 10.6 years (1.5-22). Results: There were no postoperative deaths. Six (15%) patients experienced postoperative complications, with no difference between the two groups. Si xteen patients (41%) developed recurrence requiring surgery: 9 in group 1 ( 32%) and 7 in group 2 (64%) (p > 0.05). The IRA had to be removed or was no longer functional in 12 patients: 6 in group 1 (21.5%) and 6 in group 2 (5 4.5%) (p < 0.05). Conclusion: Moderate proctitis does not increase the morbidity of total col ectomy with IRA for Crohn's disease. The risk of reoperation and secondary proctectomy is higher when proctitis was present, but the IRA was still fun ctional in one-half of patients after more than 10 years of follow-up. (C) 2000 Editions scientifiques et medicates Elsevier SAS.