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Review
. 2023 Mar 1;29(3):417-422.
doi: 10.1093/ibd/izac099.

Long-Term Outcomes of the Excluded Rectum in Crohn's Disease: A Multicenter International Study

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
Affiliations
Review

Long-Term Outcomes of the Excluded Rectum in Crohn's Disease: A Multicenter International Study

Gassan Kassim et al. Inflamm Bowel Dis. .

Abstract

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.

Keywords: Crohn’s Disease; Perianal disease; Rectum; Surgery.

Plain language summary

Patients with distal Crohn’s disease often undergo colon resection with a stoma to divert the intestinal stream from the rectum in hopes of achieving sufficient healing to allow ultimate re-establishment of intestinal continuity. Patients and practitioners alike should be aware of the long-term success rates of this procedure. Our retrospective study of 197 patients found that half required later proctectomy and an additional one-quarter remained symptomatic with excluded rectums. Only 14% remained symptom-free after reanastomosis, and only 6% if perianal disease was the initial surgical indication. These data provide estimation of long-term surgical outcomes.

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Conflict of interest statement

The authors have no conflicts of interest to disclose. The current manuscript, including related data and figures, has not been previously published and is not under consideration elsewhere.

Figures

Figure 1.
Figure 1.
Primary indications for rectal exclusion.
Figure 2.
Figure 2.
Primary outcomes for all patients who underwent diversionary surgery and who had retained excluded rectums for at least 6 months postoperatively.
See this image and copyright information in PMC

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