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Updated: Sep 24, 2025
Murine Ileocolic Bowel Resection with Primary Anastomosis
Published on: October 29, 2014
Long-Term Outcomes of the Excluded Rectum in Crohn's Disease: A Multicenter International Study
Gassan Kassim1, Clara Yzet1, Nilendra Nair1
1Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Insights
Fecal diversion in Crohn's disease (CD) often leads to complications. Few patients achieve successful rectal reanastomosis without persistent symptoms or further surgery, especially those with perianal disease.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Inflammatory Bowel Disease Research
Background:
- Crohn's disease (CD) frequently necessitates fecal diversion surgery.
- Long-term outcomes of retained excluded rectums in CD patients are not well-established.
- Understanding these outcomes is crucial for surgical decision-making and patient management.
Approach:
- A multicenter review analyzed medical records of 197 CD patients.
- Inclusion criteria required diversion surgery with a retained excluded rectum for ≥6 months and ≥2 years follow-up.
- Data on subsequent proctectomy, reanastomosis, and symptom status were collected.
Key Points:
- 46.7% of patients underwent proctectomy; 53.3% retained their rectum.
- Among those with retained rectums, 47.6% were reanastomosed, 52.4% remained excluded.
- Of reanastomosed patients, 44% were symptomatic; 63.6% of excluded rectums were symptomatic.
- Only 14.2% of all patients achieved successful reanastomosis without issues.
Conclusions:
- Fecal diversion in CD with rectal retention has a high rate of complications.
- Successful reanastomosis without disease persistence is uncommon (<15%).
- Patients with perianal disease have particularly poor outcomes (6% success).
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 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.
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