Long-Term Complications of Proctectomy for Refractory Perianal Crohn's Disease: A Narrative Review

Abstract

Despite a combination of medical and surgical treatments, many patients with perianal Crohn's disease (CD) continue to experience refractory disease, requiring proctectomy or proctocolectomy, with the creation of a permanent stoma. Although proctectomy is seen as an ultimate treatment aimed at effectively relieving debilitating symptoms and enhancing quality of life, many patients may still face long-term and chronic complications. This narrative review aims to provide an overview of the main complications that patients undergoing proctectomy for CD may experience throughout their lives. Relevant publications addressing complications of proctectomy for refractory perianal CD were searched in the Medline/PubMed, Embase, Cochrane, and LILACS databases. The main long-term complications that patients encounter are related to impaired perineal wound healing, stoma-related issues, sexual and urinary dysfunction, small bowel obstructions, and CD recurrence. These complications negatively affect the quality of life and frequently necessitate further treatment. Patients should receive preoperative counselling regarding the implications of these particular issues, and regular follow-up must be guaranteed to identify any problems early, allowing for prompt treatment.

Keywords: Crohn’s disease; anal fistula; inflammatory bowel disease; postoperative complications; proctectomy; surgical stomas.

Figure 1

Chronic perineal sinus following proctocolectomy with end ileostomy. The image was taken during the clinical practice of the first author, Mr. Alves Martins, and an informed consent statement for the publication of the photograph was obtained from the patient.

Figure 2

Abdominal CT scan demonstrating signs of small bowel obstruction in a patient with CD following proctocolectomy with end ileostomy.