The long-term prognosis of ileorectal anastomosis and proctocolectomy in Crohn's disease.

In a series of 226 patients with Crohn's disease admitted to the University Hospital at Leiden between 1934 and 1972, 21 of the 60 patients with almost total colonic involvement were treated by an ileo-rectal anastomosis between 1957 and 1973. Sixteen patients underwent a proctocolectomy between 1948 and 1972. Five of them have previously had an ileo-rectal anastomosis and are therefore included in both groups. The patients have been followed up for a mean period of 8.3 years. There was no surgical mortality in the group of ileo-rectal anastomosis, whereas in the group of proctocolectomy there have been one early and one late postoperative death. The recurrence rate after ileo-rectal anastomosis was 75 per cent, but 40 per cent of these cases responded well to conservative treatment and have not required further surgery. The recurrence rate after proctocolectomy was 31 per cent. The results concerning mortality, morbidity, and recurrence are compared with the series in the literature.