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P687 Fate of the rectum in anorectal Crohn's disease

Zambonin D., Scaringi S., Di Bella A., Giudici F., Bechi P.

University of Florence, Florence, Italy

Background

The long term risk of permanent stoma in patients with anorectal Crohn disease is high. About 34% of patients with Crohn's disease have perianal disease. Little is known about the results of restorative surgery after enterostomy for Crohn's colitis with severe anorectal involvement.

The aim of this study is to assess the effectiveness of restorative surgery.

Methods

We retrospectively analysed a cohort of Crohn's disease patients affected by severe anorectal involvement underwent surgery from 1986 to 2016, who received an enterostomy at first surgery. We have excluded patients affected with extensive colitis and severe anorectal involvement who received total procto-colectomy. Only patients having primary surgery with an “intent to restore approach” were included in order to analyse factors (smoking, age more or less than 30 years, familiarity, type of primary surgery) affecting the probability for restoring the intestinal function.

Results

Among 24 patients undergone enterostomy with an “intent to restore approach”, the median follow-up was 16 years. Only rectal involvement was found in 3 patients (12.5%), perianal disease in 21 patients (87.5%). Patients underwent different types of surgery: 3 subtotal colectomies with rectal stapling (12.5%), 8 total colectomies with rectal stapling (33.3%), 10 rectal anterior resections with colorectal anastomosis with protective ileostomy or colostomy (41.7%), 1 ileocolic resection with ileo-colostomy (4%), 2 temporary ileostomies for severe perianal disease (8.3%). Eleven patients (45.8%) were restored, while 13 patients had permanent stoma (54.2%). The type of surgical procedure did not affect the risk of permanent stoma. Smoking habits resulted to improve the risk for permanent stoma (p=0.04, CI 95%=-1.6;1.9). Other variables showed to have a trend towards but not a statistical significance.

Conclusion

Approximatively one of two patients that had received an enterostomy at the time of surgery for Crohn's colitis with severe anorectal involvement can be restored. As a consequence, half of the patients observed, received definitive enterostomy. Smoking habits was associated with an increasing risk of permanent stoma, but other variables could be involved.