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

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 unde...

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Veröffentlicht in:Inflammatory bowel diseases 2023-03, Vol.29 (3), p.417-422
Hauptverfasser: Kassim, Gassan, Yzet, Clara, Nair, Nilendra, Debebe, Anketse, Rendon, Alexa, Colombel, Jean-Frédéric, Traboulsi, Cindy, Rubin, David T, Maroli, Annalisa, Coppola, Elisabetta, Carvello, Michele M, Ben David, Nadat, De Lucia, Francesca, Sacchi, Matteo, Danese, Silvio, Spinelli, Antonino, Hirdes, Meike M C, ten Hove, Joren, Oldenburg, Bas, Cholapranee, Aurada, Riter, Maxine, Lukin, Dana, Scherl, Ellen, Eren, Esen, Sultan, Keith S, Axelrad, Jordan, Sachar, David B
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container_end_page 422
container_issue 3
container_start_page 417
container_title Inflammatory bowel diseases
container_volume 29
creator Kassim, Gassan
Yzet, Clara
Nair, Nilendra
Debebe, Anketse
Rendon, Alexa
Colombel, Jean-Frédéric
Traboulsi, Cindy
Rubin, David T
Maroli, Annalisa
Coppola, Elisabetta
Carvello, Michele M
Ben David, Nadat
De Lucia, Francesca
Sacchi, Matteo
Danese, Silvio
Spinelli, Antonino
Hirdes, Meike M C
ten Hove, Joren
Oldenburg, Bas
Cholapranee, Aurada
Riter, Maxine
Lukin, Dana
Scherl, Ellen
Eren, Esen
Sultan, Keith S
Axelrad, Jordan
Sachar, David B
description 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. Lay 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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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. Lay 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.</description><identifier>ISSN: 1078-0998</identifier><identifier>EISSN: 1536-4844</identifier><identifier>DOI: 10.1093/ibd/izac099</identifier><identifier>PMID: 35522225</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Clinical Research ; Crohn Disease - surgery ; Feces ; Humans ; Multicenter Studies as Topic ; Pelvis ; Proctectomy ; Rectum - surgery ; Retrospective Studies ; Treatment Outcome</subject><ispartof>Inflammatory bowel diseases, 2023-03, Vol.29 (3), p.417-422</ispartof><rights>The Author(s) 2022. Published by Oxford University Press on behalf of Crohn’s &amp; Colitis Foundation. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 2022</rights><rights>The Author(s) 2022. Published by Oxford University Press on behalf of Crohn’s &amp; Colitis Foundation. All rights reserved. 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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. Lay 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.</description><subject>Clinical Research</subject><subject>Crohn Disease - surgery</subject><subject>Feces</subject><subject>Humans</subject><subject>Multicenter Studies as Topic</subject><subject>Pelvis</subject><subject>Proctectomy</subject><subject>Rectum - surgery</subject><subject>Retrospective Studies</subject><subject>Treatment Outcome</subject><issn>1078-0998</issn><issn>1536-4844</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kctq3DAUhkVoyGWaVfZFq1IITiTZsuVuSpgkbWBKoE3XQpaOMyq2NdWlJF31NfJ6eZJomGloN9UBSUgf_7n8CB1TckpJW57ZzpzZX0qTtt1BB5SXdVGJqnqV76QRRX4W--gwhO-EsBztHtovOWd58QOkFm66K27Bj_gmRe1GCNj1OC4BX97rIRkw-AvomEZsJzz3bjk9_X4M-MIGUAHe43P8OQ3RapgieHy93icVrZvUgL_GZB5eo91eDQGOtucMfbu6vJ1_KhY3H6_n54tCV7SMhWaUmRIqonnT94y1oqKq4Q2o3BEpTauIYI3mnemFrkgpaqpNz4TmpGu46MoZ-rDRXaVuBLMuyKtBrrwdlX-QTln5789kl_LO_ZSUMErqnGWG3m0VvPuRIEQ52qBhGNQELgXJ6no90TzEjJ5sUO1dCB76lzyUyLUrMrsit65k-s3fpb2wf2zIwNsN4NLqv0rPzbWYGw</recordid><startdate>20230301</startdate><enddate>20230301</enddate><creator>Kassim, Gassan</creator><creator>Yzet, Clara</creator><creator>Nair, Nilendra</creator><creator>Debebe, Anketse</creator><creator>Rendon, Alexa</creator><creator>Colombel, Jean-Frédéric</creator><creator>Traboulsi, Cindy</creator><creator>Rubin, David T</creator><creator>Maroli, Annalisa</creator><creator>Coppola, Elisabetta</creator><creator>Carvello, Michele M</creator><creator>Ben David, Nadat</creator><creator>De Lucia, Francesca</creator><creator>Sacchi, Matteo</creator><creator>Danese, Silvio</creator><creator>Spinelli, Antonino</creator><creator>Hirdes, Meike M C</creator><creator>ten Hove, Joren</creator><creator>Oldenburg, Bas</creator><creator>Cholapranee, Aurada</creator><creator>Riter, Maxine</creator><creator>Lukin, Dana</creator><creator>Scherl, Ellen</creator><creator>Eren, Esen</creator><creator>Sultan, Keith S</creator><creator>Axelrad, Jordan</creator><creator>Sachar, David B</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-1951-7790</orcidid><orcidid>https://orcid.org/0000-0003-4581-2267</orcidid><orcidid>https://orcid.org/0000-0002-9820-3660</orcidid></search><sort><creationdate>20230301</creationdate><title>Long-Term Outcomes of the Excluded Rectum in Crohn’s Disease: A Multicenter International Study</title><author>Kassim, Gassan ; 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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. Lay 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.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>35522225</pmid><doi>10.1093/ibd/izac099</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-1951-7790</orcidid><orcidid>https://orcid.org/0000-0003-4581-2267</orcidid><orcidid>https://orcid.org/0000-0002-9820-3660</orcidid><oa>free_for_read</oa></addata></record>
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subjects Clinical Research
Crohn Disease - surgery
Feces
Humans
Multicenter Studies as Topic
Pelvis
Proctectomy
Rectum - surgery
Retrospective Studies
Treatment Outcome
title Long-Term Outcomes of the Excluded Rectum in Crohn’s Disease: A Multicenter International Study
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