- Fecal Incontinence
|Long-Term Outcomes of the Excluded Rectum in Crohn's Disease: A Multicenter International Study
Inflamm Bowel Dis. 2023 Mar 1;29(3):417-422. doi: 10.1093/ibd/izac099.
Gassan Kassim 1, Clara Yzet 1, Nilendra Nair 1, Anketse Debebe 1, Alexa Rendon 1, Jean-Frédéric Colombel 1, Cindy Traboulsi 2, David T Rubin 2, Annalisa Maroli 3, Elisabetta Coppola 3, Michele M Carvello 3, Nadat Ben David 3, Francesca De Lucia 3, Matteo Sacchi 3, Silvio Danese 3, Antonino Spinelli 3, Meike M C Hirdes 4, Joren Ten Hove 4, Bas Oldenburg 4, Aurada Cholapranee 5, Maxine Riter 6, Dana Lukin 7, Ellen Scherl 7, Esen Eren 8, Keith S Sultan 5, Jordan Axelrad 8, David B Sachar 1
1Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
2University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA.
3Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy.
4Division of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.
5Division of Gastroenterology and Hepatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
6Division of Gastroenterology and Hepatology, Weill Cornell Medical College, NY, USA.
7Jill Roberts Center for IBD, Weill Cornell Medicine, NY, USA.
8Inflammatory Bowel Disease Center at NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA.
Background: Many patients with Crohn's disease (CD) require fecal diversion. To understand the long-term outcomes, we performed a multicenter review of the experience with retained excluded rectums.
Methods: We reviewed the medical records of all CD patients between 1990 and 2014 who had undergone diversionary surgery with retention of the excluded rectum for at least 6 months and who had at least 2 years of postoperative follow-up.
Results: From all the CD patients in the institutions' databases, there were 197 who met all our inclusion criteria. A total of 92 (46.7%) of 197 patients ultimately underwent subsequent proctectomy, while 105 (53.3%) still had retained rectums at time of last follow-up. Among these 105 patients with retained rectums, 50 (47.6%) underwent reanastomosis, while the other 55 (52.4%) retained excluded rectums. Of these 55 patients whose rectums remained excluded, 20 (36.4%) were symptom-free, but the other 35 (63.6%) were symptomatic. Among the 50 patients who had been reconnected, 28 (56%) were symptom-free, while 22(44%) were symptomatic. From our entire cohort of 197 cases, 149 (75.6%) either ultimately lost their rectums or remained symptomatic with retained rectums, while only 28 (14.2%) of 197, and only 4 (5.9%) of 66 with initial perianal disease, were able to achieve reanastomosis without further problems. Four patients developed anorectal dysplasia or cancer.
Conclusions: In this multicenter cohort of patients with CD who had fecal diversion, fewer than 15%, and only 6% with perianal disease, achieved reanastomosis without experiencing disease persistence.