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AIM:Temporary faecal diversion after ileocolic resection for Crohn's disease reduces postoperative anastomotic complications in high-risk patients. The aim of this study was to assess if this approach also reduces long-term surgical recurrence. METHOD:Multicentre retrospective review of prospectively maintained databases. Patient demographics, medical and surgical details were collected by three specialist centres. All patients had undergone an ileocolic resection between 2000-2012. The primary endpoint was surgical recurrence. RESULTS:312 patients (80%) underwent an ileocolic resection without covering ileostomy (one-stage). 77 (20%) had undergone an ileocolic resection with end ileostomy / double barrel ileostomy / enterocolostomy followed by closure (two-stage). The median follow-up was 105 months (interquartile range 76-136). The median time to ileostomy closure was 9 months (interquartile range 5-12). There was no significant difference in surgical recurrence between the one- and two-stage group (18% vs 16%, P=0.94). We noted that smokers (20% vs 34%, P=0.01) and patients with penetrating disease (28% vs 52%, P< 0.01) were more likely to be defunctioned. A reduced recurrence rate was observed in the small high-risk group of patients who were smokers with penetrating disease behaviour, treated with a two-stage strategy (0/10 vs 4/7, P=0.12). CONCLUSION:In spite of having higher base-line risk factors, the results in terms of rate of surgical recurrence over 9 years are similar for patients having a two-stage compared to a one-stage procedure.

Original publication




Journal article


Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

Publication Date



Department of Colorectal Surgery, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.