The prognosis of ileorectal anastomosis in Crohn's disease.

A total of 105 patients have been treated with colectomy and ileorectal anastomosis from 1958 to 1978 in Birmingham, England (48) and in Leiden, Netherlands (57). At the end of 1978 the mean follow-up was 7.6 years (6 months-20 years). Mild or moderate degrees of proctitis were not considered as contraindications for ileorectal anastomosis. The presence or absence of ileal disease or perianal disease at the time of ileorectal anastomosis did not effect the long term prognosis but patients with sigmoidoscopic proctitis appeared to fare less well (69 per cent still functioning) than those with an apparently normal rectum (87 per cent). However, no statistical significance was obtained. The risk of reoperation for recurrence of Crohn's disease after ileorectal anastomosis calculated by actuarial methods shows a 50 per cent cumulative reoperation rate after 16-20 years. This result suggests that ileorectal anastomosis is a safe and useful procedure for most patients with Crohn's colitis who did not have severe proctitis.