Are Complications of Subtotal Colectomy with Ileorectal Anastomosis Related to the Original Disease?

Abstract

The aim of this study was to compare the morbidity of subtotal colectomy with ileorectal anastomosis performed for colonic inertia, Crohn's disease, familial adenomatous polyposis, and colorectal neoplasia. A retrospective review of all patients who underwent elective colectomy with ileorectal anastomosis between June 1988 and November 1996 was performed. The patients were divided into three groups: Group I, colonic inertia; Group II, Crohn's disease; and Group III, Familial Adenomatous Polyposis or other neoplasia. Outcome factors studied included the frequency of bowel movements, the incidence of small bowel obstruction, and the incidence of anastomotic leakage. Other factors assessed included operative time, intraoperative blood loss, length of hospitalization, level of ileorectal anastomosis, time of first bowel movement, and whether the operation was undertaken in one or two stages. Statistical analysis was undertaken by using the chi-square test and the Mann-Whitney U exact test. All 48 patients in Group I were operated on in one stage. In Group II (30 patients) 15 patients were operated on in one stage, eight patients had a preliminary Hartmann's operation and then ileorectal anastomosis, and seven patients underwent subtotal colectomy with both an ileorectal anastomosis and a proximal loop ileostomy. In Group III (22 patients) 20 patients underwent a one-stage operation whereas two patients underwent a subtotal colectomy with ileorectal anastomosis and proximal loop ileostomy. The median ages were 47.0 years in Group I, 43.8 in Group II, and 53.3 in Group III. Small bowel obstruction occurred in five patients (10%) in Group I, four patients (13.3%) in Group II, and four patients (18%) in Group III. The anastomotic leak rate was 4.2% (two patients) in Group I, 1% (three patients) in Group II, and 0% in Group III (P < 0.05). At the follow up interview after surgery, the mean number of bowel movements per day 6 months after surgery was 5.4 in Group I, 7.2 in Group II, and 5.6 in Group III, (P < 0.05, Group II vs Group I or Group III). Operative time in Group III was significantly longer than in the other two groups (P = 0.004). No statistically significant differences were found among the three groups relative to blood loss, hospitalization, or timing of first bowel movement. This study failed to identify any differences in either immediate perioperative outcome or morbidity or intermediate-term function in patients undergoing ileorectal anastomosis regardless of diagnosis. The overall rate of small bowel obstruction was 13 per cent with no significant differences among the three groups. Lastly although the anastomotic leak rate was not significantly higher in patients with Crohn's disease it was higher in the group with ileostomy and ileorectal anastomosis, which highlights a potential advantage of performance of this procedure in two stages in selected patients of this patient population.