[Influence of ano-perineal lesions on the outcome of the rectum in colonic and rectal Crohn disease].

Between 1960 and 1988, 83 patients (38 men, 43 women) underwent colectomy and ileorectal anastomosis (IRA) for severe colonic or rectal Crohn's disease. The mean age at IRA was 28.5 years. The mean interval from diagnosis was 4 years. There were two post-operative deaths. Among the 81 survivors 5 patients who had a covering ileostomy have never had their stomas closed and 24 patients required exclusion or excision of their IRA and rectum. (= 10 defunctioning IRA, 14 proctectomies with definitive ileostomy). The mean interval between IRA and the creation of a permanent ileostomy was 4.1 years. The mean interval between the onset of problems following IRA and permanent ileostomy was 2 years. 25 patients had perianal lesions prior to IRA. 5 of these patients had unhealed perianal disease at IRA and 7 required defunctioning ileostomy (28%). The need for rectal excision or exclusion following IRA was not related to the presence of perianal disease prior to IRA but functional results were worse. 33 patients developed perianal lesions following their IRA, among whom 19 required exclusion or excision of the rectum. Failure of IRA was then significantly higher amongst those who developed lesions following IRA. Rectal preservation after IRA may be proposed with success to patients with a healthy rectum or with minimal or moderate proctitis, even if there is perianal disease that could be safely treated before IRA. In this last setting the patient has to be informed of the risk of rectal preservation and the possible risk of requiring ulterior protectomy.