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P390 Diverting Loop Ileostomy in Medically Refractory Crohn's Colitis

Patel, P.(1);Wu, L.(2);

(1)Mid Central District Health Board, General Surgery, Palmerston North, New Zealand;(2)Waikato District Health Board, General Surgery, Waikato, New Zealand

Background

Medically Refractory Crohn’s Colitis (MRCC) necessitates surgical treatment. Patients may be malnourished, hyper-inflammatory and unstable (tachycardia, elevated temperatures and hypotension). Acute Defunctioning Ileostomy Formation Alone (DIFA) may be a safer option than total/subtotal Acute Colectomy and Ileostomy Formation (ACIF) in the urgent/semi-urgent setting - allowing optimisation of patient condition for further medical therapy or elective surgery.

 

Methods

Multi-centre, retrospective outcomes analysis was performed. Local investigators identified all patients aged ≥16 with MRCC, that underwent urgent/semi-urgent surgery between 1/1/1999 and 31/12/2019. The primary outcome was 30-day all-cause morbidity. Multiple secondary outcomes were defined relating to 30-day, 1-year and 18-month follow up.

Results

82 patients from seven hospitals satisfied selection criteria - 12 DIFA and 70 ACIF.  30-day all-cause morbidity (8.3% vs 52.9%), median length of stay (8 vs 17 days), open surgical approach (25.0% vs 75.0%) and 1-year readmission rates (25.0% vs 37.1%) were all significantly lower for the DIFA group. 30-day all-cause mortality, critical care admission, 30-day return to theatre and 1-year morbidity were all lower for the DIFA group. The DIFA group had a 16.7% 1-year colectomy rate and 25% 18-month ileostomy rate.

Conclusion

DIFA is a safe alternative to ACIF for surgical treatment of urgent/semi-urgent MRCC. Larger scale prospective studies are warranted to confirm this.

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