Rectal Preservation in Nonspecific Inflammatory Disease of the Colon

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Abstract
Patients (63) with chronic ulcerative colitis and 80 patients with Crohn''s disease underwent abdominal colectomy and primary ileorectal or ileosigmoid anastomosis and were followed up for between 5 and 17 yr. No patient developed carcinoma of the rectal stump. The interval proctectomy rate was similar in both groups (24 and 29%, respectively), the rate being influenced by age in the group with chronic ulcerative colitis. Young patients with ulcerative colitis required proctectomy more often than did patients with onset later in life. The proctectomy rate was not influenced by the level of the anastomosis. In patients with normal or moderately diseased rectal mucosa, preoperative condition of the rectum did not influence the proctectomy rate. Functional results were satisfactory in 55% of patients with chronic ulcerative colitis who survived and in 35% of patients with Crohn''s disease who survived. Because of the non-curative nature of surgery for Crohn''s disease, a conservative posture should be maintained, with preservation of normal or moderately diseased rectal segments. If sigmoidoscopic examination and biopsy are done periodically, abdominal colectomy and ileorectal or ileosigmoid anastomosis appear to be a variable option to proctocolectomy in selected patients with chronic ulcerative colitis.