Efficacy and problems of fecal diversion for intractable anorectal complications of Crohn's disease

Abstract

Introduction: The effects of fecal diversion in intractable anorectal complications of Crohn's disease are controversial. Materials and Methods: We studied the efffects of fecal diversion in 42 patients with Crohn's disease (24 men and 18 women) with intractable anorectal complications. Indications for fecal diversion involved with complex perianal fistula (36 patients), anorectal stenosis (22), ano- or rectovaginal fistula (11), rectal fistula (3), perirectal (intrapelvic) abscess (2), rectoperineal fistula (1), and rectourethral fistula (1). Results: After diversion, symptoms improved in 31 of 42 patients, remained unchanged in 4, and worsened in 3. Four patients, improving initially had later recurrence. All rectal fistulas, intrapelvic abscesses, rectoperineal fistulas, and rectourethral fistulas healed, as did 26 of 36 complex fistulas, but most anorectal stenosis and ano- (or recto-) vaginal fistulas did not. Despite improvement, 15 of 16 patients with closure of stoma had recurrent anorectal complications and required rediversion. Overall, only 4 had restored intestinal continuity. Ten needed proctectomy, and 28 remained with fecal diversion. Conclusions: Fecal diversion improves the symptoms of anorectal complications but does not result in healing anorectal lesions and seldom restores intestinal continuity. ©2005 The Japanese Society of Gastroenterological Surgery.