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Total colectomy for Crohn's disease

N Rieger1, B Collopy, R Fink

  • 1Department of Colon and Rectal Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia. rieger@powerup.com.au

The Australian and New Zealand Journal of Surgery
|February 5, 1999
PubMed
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A permanent ileostomy is common after total colectomy for Crohn's disease. Rectal disease significantly increases the likelihood of needing a permanent ileostomy, impacting surgical outcomes.

Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Colorectal Surgery

Background:

  • Total colectomy for Crohn's disease can be restorative (ileorectal anastomosis) or involve an ileostomy with a rectal stump.
  • Assessing the rate of permanent ileostomy and its relation to rectal disease is crucial for surgical planning.

Purpose of the Study:

  • To retrospectively audit the outcomes of total colectomy for Crohn's disease.
  • To determine the incidence of permanent ileostomy and its correlation with rectal disease at the time of surgery.

Main Methods:

  • Retrospective case note review of patients undergoing total colectomy between 1968 and 1994.
  • Analysis of surgical procedures (ileorectal anastomosis vs. total colectomy with ileostomy) and patient outcomes, including subsequent proctectomy and permanent ileostomy rates.

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Main Results:

  • Of 38 patients, 21 (57%) ultimately had a permanent ileostomy.
  • Rectal involvement at the time of the initial operation significantly increased the likelihood of requiring a permanent ileostomy (P = 0.001).
  • Subsequent proctectomy was more common in the ileostomy group (45%) than the ileorectal anastomosis group (29%), though not statistically significant.

Conclusions:

  • Permanent ileostomy is a frequent outcome following total colectomy for Crohn's disease.
  • Pre-existing rectal disease is a significant predictor of the need for a permanent ileostomy.