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

摘要

PURPOSEcolon;There is a difference of opinion concerning the role of ileal pouchhyphen;anal anastomosis in Crohn's disease, even in the absence of smallhyphen;bowel or perianal disease. One view is that ileal pouchhyphen;anal anastomosis should never be entertained, the other is that ileal pouchhyphen;anal anastomosis, like ileoproctostomy, can be justified sometimes, because it allows young people a period of stomahyphen;free life. The aim of this study was to examine the outcome of ileal pouchhyphen;anal anastomosis and to contrast it with ileoproctostomy in patients with Crohn's disease without smallhyphen;bowel or perianal disease.METHODScolon;Ileal pouchhyphen;anal anastomosis was performed in 23 patients with Crohn's disease lpar;12 of whom had evidence of Crohn's disease at the time of operation and 11 who were eventually found to have Crohn's disease as a result of complicationsrpar; and ileoproctostomy in 35. Patients were matched for age, gender, followhyphen;up, and medication, but all ileoproctostomy cases had relative rectal sparing. Thus, the groups were not comparable and the reasons for ileal pouchhyphen;anal anastomosis and ileoproctostomy were therefore quite different.RESULTScolon;The outcome in ileal pouchhyphen;anal anastomosis at a mean followhyphen;up of 10.2 years was pouch excision, 11 lpar;47.8 percentrpar;semi; proximal stoma, 1 lpar;4.3 percentsemi; patient preferencerpar;semi; average smallhyphen;bowel resection, 65 cmsemi; persistent perineal sinus, 8 of 11 having pouch excision lpar;73 percentrpar;semi; and mean time in hospital, 37 lpar;range, 8hyphen;108rpar; days. Of those in circuit having ileal pouchhyphen;anal anastomosis lpar;nequals;12rpar;, 24hyphen;hour bowel frequency was 6, with no incontinence or urgency, but 6 lpar;50 percentrpar; were on medication. When ileal pouchhyphen;anal anastomosis was done for Crohn's disease in the resection specimen, only 4 of 12 lpar;33 percentrpar; were excised compared with 7 of 11 lpar;64 percentrpar; in whom the diagnosis was made as a result of complications. The outcome in ileoproctostomy at a mean followhyphen;up of 10.9 years was rectal excision in 3 lpar;8 percentrpar;, proximal stoma in 1 lpar;3 percentrpar;, average smallhyphen;bowel resection was 15 cm, persistent perineal sinus in 1 lpar;3 percentrpar;, and time in hospital was 21 lpar;range, 8hyphen;36rpar; days. Of those in circuit lpar;nequals;32rpar;, 24hyphen;hour bowel frequency was 5, 2 had incontinence, 3 had urgency, and 12 lpar;36 percentrpar; were taking medication.CONCLUSIONScolon;These results indicate that the overall outcome of ileal pouchhyphen;anal anastomosis is inferior to that of ileoproctostomy, especially if Crohn's disease was diagnosed as a result of complications. Nevertheless, the functional results of those with a successful outcome are comparable.