Crohns Disease

Crohn's disease (CD) is generally a contraindication to performing an IPAA [1,25] because of the high risk of complications and illness relapse with a consequent destruction of the reservoir or its permanent loss of functionality in 30-45% of cases [41, 42]. The experience of Regimbeau et al. goes against the tide

[43]; they performed the operation in a selected group of patients with known CD, with complications in 35% of patients, reservoir excision in 10% of cases and a functional result overlapping with the result of patients suffering from UC. Despite all the perplexities shown by some authors about the criteria used by the French surgeons to diagnose CD [34], their results compel us to reconsider the issue from a different perspective, as it is not properly suitable to compare the results of IPAA for CD with results for UC and FAP

[44]. It must be emphasised that in case of Crohn's colitis, surgical relapses after 10 years since surgery are 25% after undergoing proctocolectomy and ileostomy and 50% after ileorectal anastomosis [45]. These values may well be compared with the percentages of the failure of IPAA for CD reported in the various series [42, 44, 45]. Delaini et al. [44] compared the results of two groups of patients suffering from Crohn's colitis at a distance; they underwent total proctocolectomy and continent ileostomy (Kock pouch) or conventional ileostomy. Reservoir excision was necessary due to a relapse of CD in 28% of patients with Kock pouch whereas in the group who underwent conventional ileostomy, 28% of patients underwent one or more ileal resections due to a relapse. Short-bowel syndrome occurred in 4% of patients in both groups. The results of this study show that loss of the small intestine due to pouch removal can be compared with those due to relapse after conventional ileostomy and does not inevitably lead to short-bowel syndrome. According to Delaini et al. [44], construction of a continent ileostomy and also of a pelvic reservoir in the case of selected CD (absence of ileal and anal-perineal illness) does not necessarily prognosticate a surgical catastrophe; this is a point of view that agrees with a recent study by the Cleveland Clinic [45] (12% reservoir excision, acceptable functional results, satisfactory quality of life).

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