Sphincter-sparing intersphincteric rectal resection as an alternative to proctectomy in long-standing fistulizing and stenotic XXXX ?

@entity1 @entity5 @entity256 @entity292 @entity1241 @entity850 @entity30
PURPOSE: Long-standing fistulizing and stenotic proctitis (LFSP) in @entity30 ( @entity30 ) indicates the end stage of the disease. Definitive diversion such as proctectomy is considered to be the only surgical option. The impact of intersphincteric sphincter-sparing anterior rectal resection (IAR) as an alternative to proctectomy is unclear. The aim of this study was to evaluate feasibility, morbidity, outcome, and quality of life (QL) in @entity1 with LFSP undergoing intended IAR. @entity1 AND METHODS: Out of a single institution database, 15 @entity1 with LFSP intended for surgery from 856 @entity1 with @entity30 were selected for follow-up analyses. RESULTS: In 12/15 cases, IAR was carried out while 3/15 @entity1 underwent primary proctectomy due to @entity5 (n   =   2) or due to @entity1 's wish (n   =   1). In one case, IAR revealed @entity5 , which led to secondary proctectomy. In @entity1 with IAR, complete healing of @entity292 and @entity850 was observed in 46  % (n   =   5) while 36  % (n   =   4) of @entity1 showed relapse of @entity292 and 18  % (n   =   2) developed @entity256 . Ileostomy closure was performed in seven @entity1 from which six @entity1 remained stoma free. QL and @entity1241 measured by standardized scoring systems were unchanged while stool frequency was reduced after IAR in @entity1 with ileostomy closure. The rate of @entity5 in this cohort was 20  % (n   =   3). CONCLUSION: LFSP in @entity30 was associated with 20  % of malignant transformation. Although IAR fails to improve QL, it is a suitable procedure for the treatment of @entity292 and @entity850 associated with acceptable healing rates and can avoid a permanent stoma.
