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P184 Temporary defunctioning ileostomy in therapy refractory Crohn’s colitis: A viable alternative to immediate colorectal resection?

A.M. van der Holst1, T. Otten2, A.R.P.K.M. van Renterghem1, G. Dijkstra2, E.S. van Loo3, E.M. van Praag4, C.J. Buskens4, L.P.S. Stassen1

1Department of General Surgery, Maastricht University Medical Center, Maastricht, The Netherlands, 2Department of Gastroenterology, University Medical Center Groningen, Groningen, The Netherlands, 3Department of General Surgery, University Medical Center Groningen, Groningen, The Netherlands, 4Department of General Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands

Background

The faecal stream is one of many factors influencing the pathogenesis of Crohn’s disease. Previous research demonstrated some Crohn’s patients benefit from temporary faecal diversion. This study aims to determine the role of temporary faecal diversion by means of a defunctioning ileostomy in treating patients with therapy refractory Crohn’s colitis.

Methods

Data were retrieved by retrospectively assessing patient records. All patients receiving a temporary ileostomy for therapy refractory Crohn’s colitis from three Dutch hospitals between 2010 and 2018 were included. Patients with previous colorectal resection or malignancy were excluded. Stoma reversal, permanent stoma and extension of colorectal resection at follow-up were determined as primary outcomes.

Results

Thirty-six patients received a temporary defunctioning ileostomy for therapy refractory Crohn’s colitis. Stoma reversal was attempted in 20 (56%) patients after a mean period of 1 year of which nine underwent additional resection during stoma reversal. After a mean follow-up of 4.2 years, resection was performed in 29 (81%) patients of which 14 (39%) had reduced resection in comparison with the necessary resection at the time of faecal diversion. Among the 14 (39%) patients with restored continuity, three patients remained with full preservation of the colon. Moreover, the presence of proctitis was associated with low stoma reversal rates (p = .007).

Conclusion

Temporary faecal diversion is associated with reduced resection and reduced risk of permanent ileostomy; therefore, it may be a decent alternative for immediate colorectal resection for patients with isolated Crohn’s colitis. Unfortunately, temporary defunctioning ileostomy is not a viable alternative for resection in Crohn’s patients suffering from proctitis.