[Complications and course after proctectomy for Crohn disease]

The decision to perform protectomy must be considered very seriously in the course of Crohn's disease. The objectives of this study were to evaluate the consequences of this procedure: healing, sexual disorders, quality of life and the subsequent course of the disease. From 1981 to 1993, we performed 24 proctectomies: 15 females, 9 males, mean age: 39 years (18-76), mean preoperating time: 9 +/- 4 years. Rectal and anoperineal lesions were always accompanied by pancolitis; ileal involvement was observed in 11 cases (45%) at the time of diagnosis of Crohn's disease, and in 4 cases at the time of proctectomy. Proctectomy was performed after a period of rectal exclusion in 19 patients, while the rectum was not isolated for 5 others, including 2 patients after total colectomy. The indication for surgery was based on the coexistence of a microrectum (n = 16), anal stenosis (n = 15), rectovaginal or complex fistulas (n = 15). Technical features were: close rectal dissection (n = 19), levator muscle preservation (n = 7), wall effraction (n = 8), primary closure (n = 6) or perineal wound packing (n = 8). Mean follow-up: 44 +/- 24 months, statistical analysis: Fisher's test, Wilcoxon's test and Kaplan-Meier method. No perioperative deaths were observed. An intraperitoneal collection required drainage. Mean hospital stay was 21 days. Sexual complications were: dyspareunia (n = 3), ejaculation failure (n = 1), not correlated to the type of dissection. Perineal wound healing was considered to be normal when it took less than 6 months (n = 14).(ABSTRACT TRUNCATED AT 250 WORDS)