Abstract
Aim: Creation of a diverting stoma in patients with Crohn's disease (CD) can counteract luminal inflammation. The clinical utility of a diverting stoma with the prospect of restoration of gastrointestinal continuity warrants further investigation. The aim of this work was to evaluate the long-term effects of creation of a diverting stoma on the disease course in patients with luminal colonic CD.Method: In this retrospective, multicentre cohort study we investigated the disease course of patients who received a diverting stoma in the biological era. Clinical characteristics, medication use and surgical course were assessed at the time of creation of the diverting stoma and during follow-up. The primary outcome was the rate of successful and lasting reestablishment of gastrointestinal continuity.Results: Thirty six patients with refractory luminal CD from four institutions underwent creation of a diverting stoma. Of the overall cohort, 20 (56%) patients had their gastrointestinal continuity reestablished after initial stoma creation and 14 (39%) who had their stoma reversed remained stoma-free during a median of 3.3 years follow-up (interquartile range 2.1-6.1 years). Absence of stoma reversal was associated with the presence of proctitis (p = 0.02). Colorectal resection after creation of a diverting stoma was performed in 28 (78%) patients, with 7 (19%) having a less extensive resection and 6 (17%) having a more extensive resection compared with the surgical plan before stoma creation.Conclusion: A diverting stoma could potentially be an alternative to immediate definitive stoma placement in specific populations consisting of patients with luminal colonic CD, especially in the absence of proctitis.
Original language | English |
---|---|
Pages (from-to) | 1176-1186 |
Number of pages | 11 |
Journal | Colorectal Disease |
Volume | 25 |
Issue number | 6 |
Early online date | 1 Mar 2023 |
DOIs | |
Publication status | Published - Jun 2023 |
Keywords
- abdominal surgery
- Crohn's disease
- diverting stoma
- Faecal diversion
- inflammatory bowel disease
- QUALITY-OF-LIFE
- FECAL DIVERSION
- DEFUNCTIONING STOMA
- LOOP ILEOSTOMY
- FOLLOW-UP
- MANAGEMENT
- COLITIS
- STREAM
- METAANALYSIS
- SURGERY