Intersphincteric rectal resection for fistulizing Crohn's proctitis

What is known

• In 12/15 patients undergoing IAR, complete healing of fistulas and stenosis occurred in 46%, with 36% fistula relapse and 18% restenosis. ¹
• Continence was not deteriorated by IAR, allowing a permanent stoma to be avoided or delayed. ¹
• Neither quality of life nor continence was significantly improved after IAR, and patients should be counseled QL will not change substantially. ¹
• Malignant transformation occurred in 20% of this cohort, mandating pre-op histologic sampling and local imaging (EUS/MRI) before sphincter-sparing resection. ¹

What is unknown / caveats

• Single 15-patient case series, no direct IAR-vs-proctectomy comparison arm
• No prospective or long-term controlled continence/QL data
• Whether IAR provides disease control genuinely comparable to proctectomy is untested. The corpus has no comparative outcome data.

References

1. Schlegel N, Kim M, Reibetanz J, Krajinovic K, Germer CT, Isbert C. Sphincter-sparing intersphincteric rectal resection as an alternative to proctectomy in long-standing fistulizing and stenotic Crohn's proctitis?. Int J Colorectal Dis. 2015;30(5):655-63. PMID: 25847822.

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