Abstract
Purpose
End-ileostomy after two-staged ileocolic resection is frequently performed in Crohn’s disease patients at high risk for postoperative complications. However, there is paucity on data regarding the morbidity after the stoma reversal.
Methods
One hundred thirty patients undergoing closure of end-ileostomy between 1994 and 2016 were included. Data collection was retrospective in 11 first, and it was prospective in 119 last patients. Anastomotic complications were defined as anastomotic leak, perianastomotic abscess, and perianastomotic peritonitis.
Results
The median interval between ileostomy construction and reversal was 4.0 months. Ninety-seven of 121 patients with available data (80%) gained weight between both surgeries. Hemoglobin level increased between surgeries in 107 patients (85%). Fifteen patients (11.5%) received parenteral fluid substitution or parenteral nutrition between both surgeries. There were 37 hospital readmissions during the time between stoma construction and reversal (29%). After ileostomy reversal, 14 patients developed anastomotic complications (11%). By multivariate regression analysis, preoperative steroid intake (hazard ratio 4.5, 95% CI: 1.11–18.0, p = 0.035) and hospital readmission for infectious complications (HR 4.5, 95% CI: 1.11–18.0, p = 0.035) were statistically significantly associated with an increased risk to develop postoperative anastomotic complications. There were no postoperative deaths.
Conclusion
Closure of end-ileostomy could be complicated by some serious morbidity. These risks should be taken into consideration weighing carefully between the one- and two-stage ileocolic resection in Crohn’s disease patients.
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Data availability
The datasets generated during the current study are available from the corresponding author on reasonable request.
References
Goyer P, Alves A, Bretagnol F, Bouhnik Y, Valleur P, Panis Y (2009) Impact of complex Crohn's disease on the outcome of laparoscopic ileocecal resection: a comparative clinical study in 124 patients. Dis Colon rectum 52:205–210
Adamina M, Bonovas S, Raine T, Spinelli A, Warusavitarne J, Armuzzi A, Bachmann O, Bager P, Biancone L, Bokemeyer B, Bossuyt P, Burisch J, Collins P, Doherty G, El-Hussuna A, Ellul P, Fiorino G, Frei-Lanter C, Furfaro F, Gingert C, Gionchetti P, Gisbert JP, Gomollon F, Lorenzo MG, Gordon H, Hlavaty T, Juillerat P, Katsanos K, Kopylov U, Krustins E, Kucharzik T, Lytras T, Maaser C, Magro F, Marshall JK, Myrelid P, Pellino G, Rosa I, Sabino J, Savarino E, Stassen L, Torres J, Uzzan M, Vavricka S, Verstockt B, Zmora O (2019) ECCO guidelines on therapeutics in Crohn’s disease: surgical treatment. J Crohns colitis pii: jjz187. https://doi.org/10.1093/ecco-jcc/jjz187 [Epub ahead of print]
Morar PS, Hodgkinson JD, Thalayasingam S, Koysombat K, Purcell M, Hart AL, Warusavitarne J, Faiz O (2015) Determining predictors for intra-abdominal septic complications following ileocolonic resection for Crohn’s disease-considerations in pre-operative and peri-operative optimisation techniques to improve outcome. J Crohns Colitis 9:483–491
Myrelid P, Söderholm JD, Olaison G, Sjödahl R, Andersson P (2012) Split stoma in resectional surgery of high-risk patients with ileocolonic Crohn's disease. Color Dis 14:188–193
Iesalnieks I, Kilger A, Kalisch B, Obermeier F, Schlitt HJ, Agha A (2011) Treatment of the anastomotic complications in patients with Crohn’s disease. Int J Color Dis 26:239–244
Ananthakrishnan AN, Gainer VS, Cai T, Perez RG, Cheng SC, Savova G, Chen P, Szolovits P, Xia Z, De Jager PL, Shaw S, Churchill S, Karlson EW, Kohane I, Perlis RH, Plenge RM, Murphy SN, Liao KP (2013) Similar risk of depression and anxiety following surgery or hospitalization for Crohn’s disease and ulcerative colitis. Am J Gastroenterol 108:594–601
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Iesalnieks, I., Bittermann, T., Schlitt, H.J. et al. Reversal of end-ileostomy in patients with Crohn’s disease. Int J Colorectal Dis 36, 2119–2125 (2021). https://doi.org/10.1007/s00384-020-03823-4
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DOI: https://doi.org/10.1007/s00384-020-03823-4