Long-term results of ileal pouch-anal anastomosis for colorectal Crohn's disease

INTRODUCTION: The aim of this study is to report ten-year results of ileal pouch-anal anastomosis in selected patients with colorectal Crohn's disease for whom colo-proctectomy and definitive end ileostomy was the only altern ative. METHODS: 41 patients (22females/19 males) with a mean age of 36 +/- 13 (range, 16-72) years underwent ileal pouch-anal anastomosis for colorect al Crohn's disease between 1985 to 1998. None had past or present history o f anal manifestations or evidence of small-bowel involvement. Diagnosis of Crohn's disease was established preoperatively in 26 patients, on the resec ted specimen after ileal pouch-anal anastomosis, or after occurrence of Cro hn's disease-related complication in 15 patients. RESULTS: Follow-up was 11 3 +/- 37 months, (18-174) 20 patients having been followed for more than 10 years. There was no postoperative death. Eleven (27 percent) patients expe rienced Crohn's disease-related complications, 47 +/- 34 months (8-101) aft er ileal pouch-anal anastomosis: 2 had persistent anal ulcerations with pou chitis and granulomas on pouch biopsy and were treated medically; 2 experie nced extrasphincteric abscesses and 7 presented pouch-perineal fistulas whi ch were treated surgically. Among them, 3 patients with persistent perineal fistula despite surgery required definitive end-ileostomy. Of the 20 patie nts followed for more than 10 years, 7 (35 percent) experienced Crohn's dis ease-related complications which required pouch excision in 2 (10 percent). CONCLUSIONS: Ten years after ileal pouch-anal anastomosis for colorectal C rohn's disease, rates of Crohn's disease-related complications and pouch ex cision were 35 and 10 percent, respectively. These good long-term results j ustify for us to propose ileal pouch-anal anastomosis in selected patients with colorectal Crohn's disease (i.e., no past or present history of anal m anifestations and no evidence of small-bowel involvement) for whom the only alternative is definitive end ileostomy.