Outcome of Ileorectal Anastomosis (IRA) for Crohn's Colitis (CC)
Abstracts
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Objective: To assess outcome and quality of life (QOL) of patients who had sobtotal colectomy (STC) with IRA for CC. Methods: Clinical and demographic information was collected from an IBD database and review of charts. A questionnaire was mailed to all patients with CC who had IRA performed. QOL was assessed with the SF-36 and the Inflammatory Bowel Disease Questionnaire (IBDQ) or IBDQ modified to stoma patients. Results: There were 60 patients, 25 males and 35 females. Mean age at IRA was 33 years (14-63 years), and mean follow up was 11 years (0.58-27.9 years). The indications for colectomy were failure of medical treatment in 29 (50%), bowel obstruction in 14 (23%), acute colitis in 4 (7%), colonic perforation in 3 (5%) (of which 2 were post colonoscopy perforations), abdominal abscess in 2 (3%), massive hemorrhage in one patient (2%) and coloduodenal fistula in one patient (2%). The indication was unknown in 6 patients (10%). Twenty-five patients (42%) had terminal ileal involvement. Fifty-eight patients had rectal sparing and only 2 (3%) had mild rectal involvement. Six patients had perianal disease. Forty-three IRAs (72%) were performed at colectomy, and 17 (28%) subsequently. There was no perioperative mortality. There were 5 (8%) anastomotic leaks, 2 wound infections, 1 dehiscence, and 5 bowel obstructions (all resolved nonoperatively). Thirteen patients (22%) had anastomotic resection and re-anastomosis. One patient developed rectal cancer 8 years after IRA. Twenty-six patients retained a functioning IRA, 25 underwent abdominoperineal resection (mean 80 months after IRA) and 2 have a diverting ileostomy. Seven (12%) are lost to follow up. Patients with a functioning IRA have mean 6 bowel movements/day (2-13), and 0.9/night (0-4). Most patients have excellent day and night continence: 11 (50%) are completely continent and 8 (36%) have seepage only during the day. Urgency is always present in 4 (18%) and sometimes in 13 (59%). There were no significant differences in the IBDQ results between IRA patients and those with ileostomies. With the SF-36, patients who had an ileostomy had superior results to those who retained a functioning IRA in the general health perception domain (p=0.017). Conclusions: IRA is a good option for patients with CC and rectal sparing with approximately 50% of patients retaining the rectum at 10 year follow up. However, should it fail, QOL is equally good in patients with an ileostomy. |
