Ileorectal anastomosis in patients with Crohn's disease of the colon.

Thirty-seven patients were studied who had an ileorectal anastomosis performed for Crohn's disease of the colon. Twenty-nine were done as a primary procedure and in eight the anastomosis was made after previous total or segmental colectomy. Three patients developed anastomotic leaks and all three patients died. No patient who had a diverting loop ileostomy performed at the time of ileorectal anastomosis developed anastomotic leaks before or after the ileostomy was closed. Of the 37 patients, three died postoperatively and another five have had less than a one year follow-up. Of the remaining 29 patients, 12 (41%) had recurrences in either the rectum or ileum. Half of the recurrences took place five or more years after surgery. Seven of the 12 patients with recurrences have had their anastomoses taken down. When this recurrence rate of 41% is compared with the recurrence of ileitis in patients after total colectomy and ileostomy for Crohn's disease of the colon, the incidence of recurrence is, as shown in many reports, not markedly dissimilar. Of the patients who develop a recurrence after ileorectal anastomosis, only about half will have to have their anastomoses taken down. In our study, 59% of the patients had no recurrence and another 20-5% had a recurrence but did not require 'take down' of the anastomosis. Thus, almost 80% of our patients at the time of this report have been able to lead a life unencumbered by an ileostomy, making ileorectal anastomosis for this disease a desirable procedure to consider in selected patients.