Temporary faecal diversion in ileocolic resection for Crohn's disease: is there an impact on long-term surgical recurrence?
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 prosp...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
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Wiley
2019
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| _version_ | 1797100924962865152 |
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| author | Bolckmans, R Singh, S Ratnatunga, K Wickramasinghe, D Sahnan, K Adegbola, S Kalman, D Jones, H Travis, S Warusavitarne, J Myrelid, P George, B |
| author_facet | Bolckmans, R Singh, S Ratnatunga, K Wickramasinghe, D Sahnan, K Adegbola, S Kalman, D Jones, H Travis, S Warusavitarne, J Myrelid, P George, B |
| author_sort | Bolckmans, R |
| collection | OXFORD |
| description | 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. |
| first_indexed | 2024-03-07T05:44:37Z |
| format | Journal article |
| id | oxford-uuid:e6c81ea8-d016-402d-9832-30478459e4ac |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T05:44:37Z |
| publishDate | 2019 |
| publisher | Wiley |
| record_format | dspace |
| spelling | oxford-uuid:e6c81ea8-d016-402d-9832-30478459e4ac2022-03-27T10:33:38ZTemporary faecal diversion in ileocolic resection for Crohn's disease: is there an impact on long-term surgical recurrence?Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:e6c81ea8-d016-402d-9832-30478459e4acEnglishSymplectic Elements at OxfordWiley2019Bolckmans, RSingh, SRatnatunga, KWickramasinghe, DSahnan, KAdegbola, SKalman, DJones, HTravis, SWarusavitarne, JMyrelid, PGeorge, BAIM: 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. |
| spellingShingle | Bolckmans, R Singh, S Ratnatunga, K Wickramasinghe, D Sahnan, K Adegbola, S Kalman, D Jones, H Travis, S Warusavitarne, J Myrelid, P George, B Temporary faecal diversion in ileocolic resection for Crohn's disease: is there an impact on long-term surgical recurrence? |
| title | Temporary faecal diversion in ileocolic resection for Crohn's disease: is there an impact on long-term surgical recurrence? |
| title_full | Temporary faecal diversion in ileocolic resection for Crohn's disease: is there an impact on long-term surgical recurrence? |
| title_fullStr | Temporary faecal diversion in ileocolic resection for Crohn's disease: is there an impact on long-term surgical recurrence? |
| title_full_unstemmed | Temporary faecal diversion in ileocolic resection for Crohn's disease: is there an impact on long-term surgical recurrence? |
| title_short | Temporary faecal diversion in ileocolic resection for Crohn's disease: is there an impact on long-term surgical recurrence? |
| title_sort | temporary faecal diversion in ileocolic resection for crohn s disease is there an impact on long term surgical recurrence |
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