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Sphincter-sparing intersphincteric rectal resection as an alternative to proctectomy in long-standing fistulizing and stenotic Crohn’s proctitis?

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Long-standing fistulizing and stenotic proctitis (LFSP) in Crohn’s disease (CD) indicates the end stage of the disease. Definitive diversion such as proctectomy is considered to be the only surgical option. The impact of intersphincteric sphincter-sparing anterior rectal resection (IAR) as an alternative to proctectomy is unclear. The aim of this study was to evaluate feasibility, morbidity, outcome, and quality of life (QL) in patients with LFSP undergoing intended IAR.

Patients and methods

Out of a single institution database, 15 patients with LFSP intended for surgery from 856 patients with CD were selected for follow-up analyses.

Results

In 12/15 cases, IAR was carried out while 3/15 patients underwent primary proctectomy due to malignancy (n = 2) or due to patient’s wish (n = 1). In one case, IAR revealed unexpected malignancy, which led to secondary proctectomy. In patients with IAR, complete healing of fistulas and stenosis was observed in 46 % (n = 5) while 36 % (n = 4) of patients showed relapse of fistula and 18 % (n = 2) developed restenosis. Ileostomy closure was performed in seven patients from which six patients remained stoma free. QL and fecal incontinence measured by standardized scoring systems were unchanged while stool frequency was reduced after IAR in patients with ileostomy closure. The rate of malignancy in this cohort was 20 % (n = 3).

Conclusion

LFSP in CD was associated with 20 % of malignant transformation. Although IAR fails to improve QL, it is a suitable procedure for the treatment of fistulas and stenosis associated with acceptable healing rates and can avoid a permanent stoma.

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Conflicts of interest

None of the authors has conflicts of interest to declare.

Funding

No funding was received for this study from any organization.

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Author notes

  1. Christoph Isbert

    Present address: Evang. Amalie Sieveking-Krankenhaus, Department for General, Visceral and coloproctological Surgery, Haselkamp 33, 22359, Hamburg, Germany

Authors and Affiliations

  1. Department of General-, Visceral-, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Oberdürrbacherstraße 6, 97080, Wuerzburg, Germany

    Nicolas Schlegel, Mia Kim, Joachim Reibetanz, Katica Krajinovic, Christoph-Thomas Germer & Christoph Isbert

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  1. Nicolas Schlegel
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  2. Mia Kim
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Correspondence to Nicolas Schlegel.

Additional information

Nicolas Schlegel and Mia Kim contributed equally to this work.

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Schlegel, N., Kim, M., Reibetanz, J. et al. Sphincter-sparing intersphincteric rectal resection as an alternative to proctectomy in long-standing fistulizing and stenotic Crohn’s proctitis?. Int J Colorectal Dis 30, 655–663 (2015). https://doi.org/10.1007/s00384-015-2201-2

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