Long-Term Outcomes of the Excluded Rectum in Crohn's Disease: A Multicenter International Study
Kassim, Gassan; Yzet, Clara; Nair, Nilendra; Debebe, Anketse; Rendon, Alexa; Colombel, Jean-Frédéric; Traboulsi, Cindy; Rubin, David T; Maroli, Annalisa; Coppola, Elisabetta; Carvello, Michele M; Ben David, Nadat; De Lucia, Francesca; Sacchi, Matteo; Danese, Silvio; Spinelli, Antonino; Hirdes, Meike M C; Ten Hove, Joren; Oldenburg, Bas; Cholapranee, Aurada; Riter, Maxine; Lukin, Dana; Scherl, Ellen; Eren, Esen; Sultan, Keith S; Axelrad, Jordan; Sachar, David B
(2023) Inflammatory bowel diseases, volume 29, issue 3, pp. 417 - 422
(Article)
Abstract
Background: Many patients with Crohn’s disease (CD) require fecal diversion. To understand the long-term outcomes, we performed a multicenter review of the experience with retained excluded rectums. Methods: We reviewed the medical records of all CD patients between 1990 and 2014 who had undergone diversionary surgery with retention of the
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excluded rectum for at least 6 months and who had at least 2 years of postoperative follow-up. Results: From all the CD patients in the institutions’ databases, there were 197 who met all our inclusion criteria. A total of 92 (46.7%) of 197 patients ultimately underwent subsequent proctectomy, while 105 (53.3%) still had retained rectums at time of last follow-up. Among these 105 patients with retained rectums, 50 (47.6%) underwent reanastomosis, while the other 55 (52.4%) retained excluded rectums. Of these 55 patients whose rectums remained excluded, 20 (36.4%) were symptom-free, but the other 35 (63.6%) were symptomatic. Among the 50 patients who had been reconnected, 28 (56%) were symptom-free, while 22(44%) were symptomatic. From our entire cohort of 197 cases, 149 (75.6%) either ultimately lost their rectums or remained symptomatic with retained rectums, while only 28 (14.2%) of 197, and only 4 (5.9%) of 66 with initial perianal disease, were able to achieve reanastomosis without further problems. Four patients developed anorectal dysplasia or cancer. Conclusions: In this multicenter cohort of patients with CD who had fecal diversion, fewer than 15%, and only 6% with perianal disease, achieved reanastomosis without experiencing disease persistence. Patients with distal Crohn’s disease often undergo colon resection with a stoma to divert the intestinal stream from the rectum in hopes of achieving sufficient healing to allow ultimate re-establishment of intestinal continuity. Patients and practitioners alike should be aware of the long-term success rates of this procedure. Our retrospective study of 197 patients found that half required later proctectomy and an additional one-quarter remained symptomatic with excluded rectums. Only 14% remained symptom-free after reanastomosis, and only 6% if perianal disease was the initial surgical indication. These data provide estimation of long-term surgical outcomes.
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Keywords: Crohn's Disease, Perianal disease, Rectum, Surgery, Crohn’s Disease, Gastroenterology, Immunology and Allergy
ISSN: 1078-0998
Publisher: John Wiley and Sons Inc.
Note: Publisher Copyright: © The Author(s) 2022. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved.
(Peer reviewed)