Is There a Role for Ileal Pouch Anal Anastomosis in Crohn's Disease?

Abstract

Traditionally, surgical interventions for colonic Crohn's disease (CD) have been limited to total abdominal colectomy and ileorectal anastomosis, or total proctocolectomy with end ileostomy if there is rectal involvement. However, improved understandings of the biology of CD, as well as the development of biologic therapies, have enabled more limited resections. Here, we review the indications for, and limitations of, specific procedures aiming to preserve intestinal continuity in colonic CD.

The impact of colectomy on the course of extraintestinal manifestations in Swiss inflammatory bowel disease cohort study patients

“…In contrast to UC, where total proctocolectomy represents the surgical strategy of choice, numerous surgical techniques for CD are available, depending on segmental intestinal involvement, extension of disease, presence of local penetrating complications as well as the surgeon’s or patient’s preference 8,9 . Due to better functional results of segmental colectomy, 10 total colectomy in CD is reserved for extensive colonic involvement including a large proportion of the colon and the rectum or severe to fulminant disease activity 8,11 …”

“… 8 , 9 Due to better functional results of segmental colectomy, 10 total colectomy in CD is reserved for extensive colonic involvement including a large proportion of the colon and the rectum or severe to fulminant disease activity. 8 , 11 …”

“…8,9 Due to better functional results of segmental colectomy, 10 total colectomy in CD is reserved for extensive colonic involvement including a large proportion of the colon and the rectum or severe to fulminant disease activity. 8,11 In a considerable fraction of IBD patients the disease is not limited to the colon and/or small bowel but also affects other organ systems including joints, skin, liver and eyes, subsumed under the term extraintestinal manifestations (EIMs). Between 10% and 45% [12][13][14] of IBD patients suffer from EIM, mostly arthropathies, but also aphthous stomatitis, primary sclerosing cholangitis (PSC), uveitis, erythema nodosum and pyoderma gangrenosum.…”

Upper Gastrointestinal Tract Involvement in Inflammatory Bowel Diseases: Histologic Clues and Pitfalls

“… 99 , 100 Therefore, IPAA can only be offered for carefully selected CD patients without terminal ileal and perianal involvement, who are motivated to maintain intestinal continuity and can accept the risk of increased pouch-associated morbidity. 102 …”

“…99,100 Therefore, IPAA can only be offered for carefully selected CD patients without terminal ileal and perianal involvement, who are motivated to maintain intestinal continuity and can accept the risk of increased pouch-associated morbidity. 102 Patients who underwent IPAA surgery can develop a range of distinctive inflammatory complications that can be classified according to the bowel segment that the process involves. Inflammation involving the ileum proximal to the pouch is labeled as prepouch ileitis.…”