Open AccessProximal Recurrence and the Fate of the Rectum following Excisional Surgery for Crohn 's Disease of the Large Bowel
Author(s) -
Michael Lock,
Victor W. Fazio,
Richard G. Farmer,
David G. Jagelman,
Ian C. Lavery,
Frank L. Weakley
Publication year - 1981
Publication title -
annals of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.153
H-Index - 309
eISSN - 1528-1140
pISSN - 0003-4932
DOI - 10.1097/00000658-198112000-00016
Subject(s) - medicine , rectum , incidence (geometry) , ileostomy , surgery , crohn's disease , anastomosis , ileum , cumulative incidence , colectomy , disease , terminal ileum , gastroenterology , ulcerative colitis , physics , transplantation , optics
One-hundred-twenty-seven patients with Crohn's disease of the large bowel underwent excisional surgery with the establishment of an ileostomy at the Cleveland Clinic between 1955 and 1973; the distribution of disease at this initial resection could be accurately determined. A mean follow-up period of 11 1/2 years has shown that the overall incidence of recurrence requiring resection was 27% and the cumulative risk of recurrence determined by actuarial methods was 44% (+/- 10.6%) at 19 years. Initial involvement of the terminal ileum in addition to the large bowel was associated with a significantly higher incidence of overall recurrence (p less than 0.05) and earlier postoperative recurrence (46% +/- 9% at 11 years), when compared with patients who had ileal sparing (23% +/- 5% at 11 years). This suggests that involvement of the terminal ileum in patients with Crohn's disease of the large bowel may be of prognostic importance. Of 101 patients who had a subtotal colectomy with rectal preservation, 58 subsequently underwent either rectal excision (46 patients), ileorectal anastomosis (six patients) or both of these operations (six patients); this high incidence of reoperation should not be confused with recurrence.