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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

DOI

10.1111/codi.14895

Type

Journal article

Journal

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

Publication Date

12/11/2019

Addresses

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