Is there a place for ileal pouch-anal anastomosis in patients with Crohn's colitis?

It is generally agreed that ileal pouch-anal anastomosis (IPAA) is contraindicated in patients with Crohn's disease (CD), since recurrent disease will frequently necessitate pouch excision, thereby fostering to the ultimate development of a short bowel syndrome. For these reasons, patients with CD requiring coloproctectomy have up till now undergone definitive end ileostomy. However, when faced with the prospect of definitive ileostomy in young patients, the possibility to keep, even for a few years before the disease recurs, acceptable continence and defecation must be stressed. Although the failure rate is higher in patients with CD than in patients with ulcerative colitis, long-term results from recent reports, as well as from our own experience, demonstrated that in selected patients with CD (i.e. without anoperineal or ileal manifestations), pouch can be maintain in function in 55 to 90% of the patients. In these patients functional results are similar to those of patients with ulcerative colitis. In conclusion, unlike the authors who consider that IPPA is definitely contraindicated in CD, we believe that IPAA could be proposed for selected patients with CD for whom rectal resection is mandatory, as an alternative to coloproctectomy with definitive end ileostomy. The patients concerned are those with no history of anal manifestations and no evidence of small bowel involvement.