Outcome of colectomy and ileorectal anastomosis in Crohn's disease.

The outcome of 42 patients undergoing colectomy and ileorectal anastomosis (IRA) for Crohn's colitis, which largely spared the rectum, was studied. Operative mortality was 7% (3 patients) and each patient died as a result of anastomotic breakdown. The overall incidence of anastomotic breakdown was 16.7% (7 patients). This complication was higher following a primary anastomosis (6 of 26 patients: 23%), compared with a delayed anastomosis (1 of 16 patients: 6.3%). Patients were followed up for a median of 7 years (range 3 months-20 years) and questioned with regard to their quality of life. Cumulative reoperation rates at 5 years were 55%, and at 10 years were 74%. Most patients assessed following surgery enjoyed an unrestricted social life and none would contemplate the alternative of an ileostomy. The study suggests that despite the high incidence of recurrence, the quality of life following surgery can be good and supports the view that colectomy and ileorectal anastomosis can be used as an alternative to proctocolectomy in the treatment of Crohn's colitis for a select group of patients.