Devastating perianal complications such as severe recurrent abscesses and fistulae, incontinence and anal stenosis, may lead to proctectomy if local procedures are unsuccessful. Fortunately, less than 20% of patients with a history of anorectal Crohn's disease require permanent diversion and/or proctectomy [5, 42]. It is important to consider that the timing of proctectomy must be dictated by the patient. It is at this point when they believe that all other medical and surgical interventions have been exhausted. Patients need to be psychologically prepared because this surgical procedure creates a permanent and definitive stoma. Proctectomy is the last surgical procedure for perianal Crohn's disease and gives patients the best chance for success. It may be curative in 5% of patients with Crohn's disease localised to this region .
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