|
Back to 2016 Annual Meeting
Restorative Proctectomy for Crohn's Proctitis: Resurrecting the Turnbull-Cutait Coloanal Anastomosis
Sameer Memon, Emre Gorgun, Huriye Hande Aydinli*, Luca Stocchi, Tracy L. Hull, James M. Church, Feza H. Remzi
Colorectal Surgery, Cleveland Clinic, Cleveland, OH
INTRODUCTION: Restorative proctectomy is usually not considered for Crohn's proctitis due to the risks of recurrent perianal and colonic disease and compromised functional outcomes. However some patients are strongly motivated to avoid a permanent ileostomy. In such patients, restorative proctocolectomy can be facilitated by the Turnbull-Cutait anastomotic technique. The aim of this study is to assess the outcomes of restorative proctectomy in patients with complicated rectal Crohn's disease who underwent proctectomy at our institution.
METHODS: After the institutional review board approval, patients who underwent restorative proctectomy between 1997 and 2015 were identified in the Institutional Crohn's disease database. The course of each patient was reviewed from medical records. Patients who had their follow-up performed at an outside institution and those who had no record of follow-up within the last 6 months were directly contacted to obtain follow-up information. Primary end points were avoidance of a permanent stoma, and recurrence of colonic Crohn's disease.
RESULTS: 29 patients were included. 17 patients (59%) had a prior or concurrent proximal bowel resection. 20 patients (69%) had a current or prior history of perianal disease. 17 patients underwent Turnbull-Cutait anastomosis (59%), 9 patients had a stapled anastomosis and 3 patients had a hand-sewn anastomosis. One patient died 11 years postoperatively from an unrelated reason. Median follow-up was 21 months (6-192months) with a median stoma free survival of 59 months. At most recent follow-up 15/28 patients (54%) were free of a permanent stoma. 8 patients (28%) developed recurrent Crohn's colitis and 7 of these required permanent stoma.
CONCLUSION: The Turnbull-Cutait technique for performing a colo-anal anastomosis in risky conditions has a role in patients with rectal Crohn's disease who wish to avoid a permanent stoma. Recurrent colitis is frequent and commonly the reason for permanent stoma formation; aggressive medical prophylaxis can be strongly considered in these patients following surgery.
 
Back to 2016 Annual Meeting
|
