Long-term results of ileal pouch-anal anastomosis in patients with Crohn's disease

Dis Colon Rectum. 1996 Aug;39(8):893-8. doi: 10.1007/BF02053988.


Purpose: Ileal pouch-anal anastomosis (IPAA) is the surgical treatment of choice for most patients with chronic ulcerative colitis. Crohn's disease is, however, a contraindication. Because distinction between UC and Crohn's disease can be difficult, some patients with Crohn's disease inadvertently undergo IPAA. The aim of this study was to determine the long-term outcome of patients with Crohn's disease who have undergone IPAA.

Methods: A total of 37 patients (20 men) were studied. Each had undergone mucosectomy with handsewn IPAA (J-pouch, n = 35; S-pouch, n = 1; W-pouch, n = 1). Histologic examination of the resected specimen at time of IPAA showed features of ulcerative colitiis (n = 22), indeterminate colitis (n = 9), or Crohn's disease (n = 6). The stoma was closed in all patients.

Results: A total of 11 of 37 patients developed complex fistulas (pouch-cutaneous (n = 6), pouch-vaginal (n = 4), or pouch-vesical (n = 1). Crohn's disease has recurred in the pouch (n = 20), anal canal (n = 4), pouch and anal canal (n = 10), and elsewhere (n = 3). After ten years (range, 3-14), the pouch remains in situ in 20 patients in whom frequency of bowel movement is seven times (3-10)/24 hours, in situ but defunctioned in seven patients, and excised in ten patients (failure rate, 45 percent).

Conclusions: Inadvertent IPAA for Crohn's disease is associated with a high rate of failure (45 percent) but an acceptable long-term functional result if the pouch can be kept in situ.

MeSH terms

  • Adult
  • Anal Canal / surgery*
  • Colitis, Ulcerative / diagnosis
  • Colitis, Ulcerative / surgery
  • Contraindications
  • Crohn Disease / diagnosis
  • Crohn Disease / epidemiology
  • Crohn Disease / physiopathology
  • Crohn Disease / surgery*
  • Diagnosis, Differential
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Postoperative Complications / epidemiology
  • Proctocolectomy, Restorative*
  • Recurrence
  • Registries
  • Risk Factors
  • Time Factors
  • Treatment Failure