The effect of Crohn's disease on outcomes after restorative proctocolectomy

PURPOSE: This study was designed to compare postoperative adverse events and functional outcomes after ileal pouch-anal anastomosis between patients with Crohn's disease and those with non-Crohn's disease diagnoses. METHODS: A literature search was performed to identify studies published between 1980 and 2005 comparing outcomes of patients undergoing ileal pouch-anal anastomosis for Crohn's disease, ulcerative colitis, and indeterminate colitis. Random-effect, meta-analytical techniques were used and sensitivity analysis was performed. RESULTS: Ten studies comprising 3,103 patients (Crohn's disease 225; ulcerative colitis = 2,711; indeterminate colitis 167) were included. Patients with Crohn's disease developed more anastomotic strictures than non-Crohn's disease diagnoses (odds ratio, 2.12; P = 0.05) and experienced pouch failure more frequently than patients with ulcerative colitis (Crohn's disease vs. ulcerative colitis: 32 vs. 4.8 percent, P < 0.001; Crohn's disease vs. indeterminate colitis: 38 vs. 5 percent, P < 0.001). Urgency was more common in Crohn's disease compared with non-Crohn's disease: 19 vs. 11 percent (P = 0.02). Incontinence occurred more frequently in Crohn's disease compared with non-Crohn's disease patients: 19 vs. 10 percent (odds ratio, 2.4; P = 0.01). Twenty-four-hour stool frequency did not differ significantly between Crohn's disease, ulcerative colitis, or indeterminate colitis. Patients with isolated colonic Crohn's disease were not significantly at increased risk of postoperative complications or pouch failure (P = 0.06). CONCLUSIONS: Patients with Crol-in's disease undergoing ileal pouch-anal anastomosis should be appropriately counseled toward poorer functional outcomes and higher failure compared with non-Crohn's disease patients. It maybe possible to preoperatively select patients with isolated colonic Crohn's disease who may benefit from ileal pouch-anal anastomosis with acceptable adverse outcomes.