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P169. Risk of permanent stoma in Crohn's colitis: A comparison study between pre-biological era and biological era

M. Coscia, L. Gentilini, S. Laureti, P. Gionchetti, F. Rizzello, C. Calabrese, G. Poggioli

University of Bologna, Bologna, Italy

Aim: To determine the overall risk of a permanent stoma in patients with Crohn's colitis and to analyse how, with the introduction of biological drugs, this risk and surgical approach in patients with ano-rectal involvement have been modified. Further we analysed changes on risk of fecal diversion, medical and surgical approach between early years (2002–2005) and later years (2006–2010) of Biological Era.

Materials and Methods: A total of 233 patients with Crohn's colitis operated in our surgical unit between 1995 and 2010 June were reviewed retrospectively. Use of biological drugs for the treatment of Crohn's disease started on 2002 January in our Hospital. Fifty-one patients were submitted to abdominal surgery before 2002 and they could not to be treated with biological drugs. 182 patients were operated after 2002: 73 patients were submitted to subtotal colectomy and ileorectal anastomosis for Crohn's colitis with rectal sparing, 100 patients were submitted to subtotal colectomy, terminal ileostomy and rectal sparing for Crohn's colitis with ano-rectal involvement and 9 patients were submitted to total procolectomy for total proctocolitis. Seventy-five of patients submitted subtotal colectomy, permanent ileostomy and rectal sparing have been treated with biological drugs subsequently. In the Biological Era 69 patients have been operated in Period 1 (2002–2005) and 113 in Period 2 (2006–2010).

Results: In Pre-Biological Era the probability of permanent stoma and ileo-rectal anastomosis' preservation were 61 and 39 per cent respectively. In Biological Era the probability of permanent stoma and ileorectal anastomosis' preservation were 17 and 55 per cent respectively. In patients with Crohn's colitis and ano-rectal involvement treated with biological drugs after subtotal colectomy we observed a full regression of ano-rectal lesions in 46 per cent of cases. Rate of permanent stoma in Period 1 (only infliximab) and Period 2 (infliximab and adalimumab) patients at 3 years follow up was 14 and 7 per cent respectively.

Conclusions: Rate of permanent stoma was 61 per cent in the Pre-Biological Era and 17 per cent in the Biological Era. Treatment with biological drugs in patients with Crohn's colitis and ano-rectal involvement after subtotal colectomy is safe and effective. Biological drugs introduction have modified surgical approach for this group of patients and have increased the probability of rectal preservation and ileo-rectal anastomosis. In the later years a better use of biological drugs has significantly increased the probability of rectal preservation and ileo-rectal anastomosis.