Abstract
PURPOSE: Ileal pouch-anal anastomosis (IPAA) is the surgical treatment of choice for most patients with chronic ulcerative colitis. Crohn's disease is, however, a contraindication. Because distinction between UC and Crohn's disease can be difficult, some patients with Crohn's disease inadvertently undergo IPAA. The aim of this study was to determine the long-term outcome of patients with Crohn's disease who have undergone IPAA. METHODS: A total of 37 patients (20 men) were studied. Each had undergone mucosectomy with handsewn IPAA (J-pouch, n=35; S-pouch, n=1; W-pouch, n=1). Histologic examination of the resected specimen at time of IPAA showed features of ulcerative colitis (n=22), indeterminate colitis (n=9), or Crohn's disease (n=6). The stoma was closed in all patients. RESULTS: A total of 11 of 37 patients developed complex fistulas (pouch-cutaneous (n=6), pouch-vaginal (n=4), or pouch-vesical (n=1). Crohn's disease has recurred in the pouch (n=20), anal canal (n=4), pouch and anal canal (n=10), and elsewhere (n=3). After ten years (range, 3–14), the pouch remains in situ in 20 patients in whom frequency of bowel movement is seven times (3–10)/24 hours,in situ but defunctioned in seven patients, and excised in ten patients (failure rate, 45 percent). CONCLUSIONS: Inadvertent IPAA for Crohn's disease is associated with a high rate of failure (45 percent) but an acceptable long-term functional result if the pouch can be kept in situ.
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References
Kelly KA, Pemberton JH, Wolff BG, Dozois RR. Ileal pouch-anal anastomosis. Curr Probl Surg 1992;29:65–131.
Kohler LW, Pemberton JH, Zinsmeister AR, Kelly KA. Quality of life after proctocolectomy: a comparison of Brooke ileostomy, Kock pouch and ileal pouch-anal anastomosis. Gastroenterology 1991;101:679–84.
Hyman NH, Fazio VW, Tuckson WB, Lavery IC. Consequences of ileal pouch-anal anastomosis for Crohn's disease. Dis Colon Rectum 1991;34:653–7.
Warren BF, Shepherd NA. The role of pathology in pelvic ileal reservoir surgery. Int J Colorectal Dis 1992;7:68–75.
Pezim ME, Pemberton JH, Beart RW Jr,et al. Outcome of “indeterminant” colitis following ileal pouch-anal anastomosis. Dis Colon Rectum. 1989;32:653–8.
Wells AD, McMillan I, Price AB, Ritchie JK, Nicholls RJ. Natural history of “indeterminate” colitis. Br J Surg 1991;78:179–81.
Dozois RR, Kelly KA, Beart RW Jr, Beahrs OH. Improved results with continent ileostomy. Ann Surg 1980;192:319–24.
Handelsman JC, Gottlieb LM, Hamilton SR. Crohn's disease as a contraindication to Kock pouch. Dis Colon Rectum 1993;36:840–3.
Galandiuk S, Scott NA, Dozois RR, et al. Ileal pouch-anal anastomosis: reoperation for pouch-related complications. Ann Surg 1990;212:446–54.
Deutsch AA, McLeod RS, Cullen J, Cohen Z. Results of the pelvic-pouch procedure in patients with Crohn's disease. Dis Colon Rectum 1991;34:475–7.
Wexner SD, Rothenberger DA, Jensen L,et al. Ileal pouch vaginal fistulas: incidence, etiology and management. Dis Colon Rectum 1989;32:460–5.
Schoetz DJ Jr, Coller JA, Veidenheimer MC. Can the pouch be saved? Dis Colon Rectum 1988;31:671–5.
Nicholls RJ. Controversies and practical problem solving. In: Nicholls RJ, Bartolo D, Mortensen N, eds. Restorative proctocolectomy. London: Blackwell Scientific, 1993:53–82.
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Read at the meeting of the Association of Surgeons of Great Britain and Ireland, Glasgow, United Kingdom, May 22 to 24, 1996.
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Sagar, P.M., Dozois, R.R. & Wolff, B.G. Long-term results of ileal pouch-anal anastomosis in patients with Crohn's disease. Dis Colon Rectum 39, 893–898 (1996). https://doi.org/10.1007/BF02053988
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DOI: https://doi.org/10.1007/BF02053988