Fate of the rectum and ileal recurrence rates after total colectomy for Crohn's disease.

The aim of this study was to examine the fate of the rectum and ileal recurrence rates after total colectomy for Crohn's disease. One hundred thirty patients who underwent total colectomy between 1970 and 1997 were reviewed; 65 patients underwent end ileostomy with an oversewn rectal stump (TC+I) and 65 had ileorectal anastomosis (IRA). Patients treated by TC+I had significantly more rectal involvement (93%) than those having IRA (43%) (p < 0.0001). The incidence of ileal disease at the time of colectomy was similar (TC+I 34% versus IRA 32%; p = 0.99). Rectal recurrence requiring proctectomy was significantly more common after TC+I (51%) than after IRA (26%) (p = 0.01), whereas ileal recurrence requiring resection was significantly more common after IRA (45%) than after TC+I (18%) (p = 0.002). Using Kaplan-Meier methods, the 10-year cumulative probability of proctectomy was significantly higher after TC+I than IRA (58% versus 22%; p = 0.0001), whereas the 10-year cumulative probability of ileal resection was significantly higher after IRA than TC+I (37% versus 18%; p = 0.03). In conclusion, the proctectomy rate is higher after colectomy and ileostomy probably due to a higher incidence of preoperative rectal involvement. By contrast, the ileal recurrence rate is higher after colectomy and IRA.