The following is a summary of “Long-term Outcomes and Factors Predicting Outcome of IPAA When Used Intentionally for Well-Defined Crohn’s Disease,” published in the May 2023 issue of Colon & Rectum by Aviran et al.
IPAA is thought to be contraindicated in cases of Crohn’s disease. The previous work discovered a high risk of recurrent disease with a low incidence of pouch failure when IPAA was used consciously for well-defined Crohn’s disease. This study aimed to confirm these findings over a longer time horizon in a larger cohort. The setting was a significant IBD referral facility. The trial comprised patients with preoperative colorectal Crohn’s disease who needed surgery.
Recurrence of long-term Crohn’s disease, pouch failure, and pouch functionality. There were 46 patients found. Perianal disease (n = 18; 39%), small-bowel disease (n = 16; 35%), noncaseating granuloma (n = 10; 22%), and discontinuous inflammation (colorectal skip lesions) (n = 11; 24%) were used to diagnosis Crohn’s disease. About 22 patients (48%) with recurrent Crohn’s disease based on afferent limb disease (n = 14; 30%) or pouch fistulizing disease (n = 8; 18%) emerged after a median follow-up of 93 (7-291) months. Only 4 out of the patients (9%) experienced pouch failure. No clinical condition was linked to a return of Crohn’s disease. Pouch fistula recurrence was linked with young age at surgery and short disease duration before IPAA (P = 0.003 and P = 0.03, respectively). The majority of patients (86%) reported no urgency (67%), excellent continence, and a median frequency of 6 (range, 3-9) stools per day.
A limited sample size and a retrospective design were used. In this biggest published series looking at the deliberate use of IPAA in Crohn’s disease, a high (48%) incidence of postoperative Crohn’s disease and a low (9%) incidence of pouch failure was seen. Poor outcomes were risk factors for young age and a brief disease course before surgery. Patients with colorectal Crohn’s disease who are highly motivated may think about IPAA to forgo a permanent ileostomy.
