How does pouch construction for a final diagnosis of Crohn's disease compare with ileoproctostomy for established Crohn's proctocolitis?

PURPOSE: There is a difference of opinion concerning the role of ileal pouc h-anal anastomosis in Crohn's disease, even in the absence of small-bowel o r perianal disease. One view is that ileal pouch-anal anastomosis should ne ver be entertained, the other is that ileal pouch-anal anastomosis, like il eoproctostomy, can be justified sometimes, because it allows young people a period of stoma-free life. The aim of this study was to examine the outcom e of ileal pouch-anal anastomosis and to contrast it with ileoproctostomy i n patients with Crohn's disease without small-bowel or perianal disease. ME THODS: Real pouch-anal anastomosis was performed in 23 patients with Crohn' s disease (12 of whom had evidence of Crohn's disease at the time of operat ion and 11 who were eventually found to have Crohn's disease as a result of complications) and ileoproctostomy in 35. Patients were matched for age, g ender, follow-up, and medication, but all ileoproctostomy cases had relativ e rectal sparing. Thus, the groups were not comparable and the reasons for ileal pouch-anal anastomosis and ileoproctostomy were therefore quite diffe rent. RESULTS: The outcome in ileal pouch-anal anastomosis at a mean follow -up of 10.2 years was pouch excision, 11 (47.8 percent); proximal stoma, 1 (4.3 percent; patient preference); average small-bowel resection, 65 cm; pe rsistent perineal sinus, 8 of 11 having pouch excision (73 percent); and me an time in hospital, 37 (range, 8-108) days. Of those in circuit having ile al pouch-anal anastomosis (n = 12), 24-hour bowel frequency was 6, with no incontinence or urgency, but 6 (50 percent) were on medication. When ileal pouch-anal anastomosis was done for Crohn's disease in the resection specim en, only 4 of 12 (33 percent) were excised compared with 7 of 11 (64 percen t) in whom the diagnosis was made as a result of complications. The outcome in ileoproctostomy at a mean follow-up of 10.9 years was rectal excision i n 3 (8 percent), proximal stoma in 1 (3 percent), average small-bowel resec tion was 15 cm, persistent perineal sinus in 1 (3 percent), and time in hos pital was 21 (range, 8-36) days. Of those in circuit (n = 32), 24-hour bowe l frequency was 5, 2 had incontinence, 3 had urgency, and 12 (36 percent) w ere taking medication. CONCLUSIONS: These results indicate that the overall outcome of ileal pouch-anal anastomosis is inferior to that of ileoproctos tomy, especially if Crohn's disease was diagnosed as a result of complicati ons. Nevertheless, the functional results of those with a successful outcom e are comparable.