Does faecal diversion prevent morbidity after ileocecal resection for Crohn's disease? Retrospective series of 80 cases

• Published in: ANZ journal of surgery 2017-09, Vol.87 (9), p.E74-E79
• Main Authors: Mege, Diane, Bege, Thierry, Beyer‐Berjot, Laura, Loundou, Anderson, Grimaud, Jean‐Charles, Brunet, Christian, Berdah, Stéphane
• Format: Article
• Language: English
• Subjects: Abdominal Abscess - complications; Adolescent; Adult; Aged; Anastomosis, Surgical - methods; Bypasses; Cecum - surgery; Colectomy - adverse effects; Colectomy - methods; Complications; Crohn Disease - complications; Crohn Disease - epidemiology; Crohn's disease; faecal diversion; Female; Fistulae; Health risks; Humans; ileocecal resection; Ileostomy - methods; Ileostomy - statistics & numerical data; Intestine; Intestine, Small - surgery; Kidneys; Male; Males; Middle Aged; Morbidity; Morbidity - trends; Ostomy; Patients; Perforating; Postoperative Complications - prevention & control; Postoperative Complications - surgery; Predictive Value of Tests; Renal failure; Retrospective Studies; Risk analysis; Risk Factors; Risk groups; Surgery; Surgical Stomas - statistics & numerical data; Surgical Stomas - utilization; Young Adult
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.13034

Background After ileocecal resection for Crohn's disease, a temporary faecal diversion is indicated in high‐risk patients. The impact of a temporary stoma on post‐operative morbidity has been poorly assessed so far. The aim was to analyse post‐operative morbidity of temporary faecal diversion after ileocecal resection for Crohn's disease. Methods Patients undergoing temporary faecal diversion combined with ileocecal resection were retrospectively included. Patients presenting with complications were compared with patients with an uneventful post‐operative course, to identify any predictive factor for morbidity. Results Eighty faecal diversions were performed (43 males, 33.5 (18–75) years), including 63 split stoma (79%) and 17 covering loop ileostomies (21%). Fifty‐two patients (65%) presented with a perforating disease. Post‐operative complications occurred in 15 patients (19%), 15 days after surgery (1–30). The main complications were intra‐abdominal abscess (n = 6), functional renal failure (n = 6), fistula (n = 2) and stomal prolapse (n = 2). Two patients required surgery. Previous bowel resections (60% versus 28%, P = 0.01) were significantly associated with post‐operative morbidity. Conclusions Temporary faecal diversion is useful in high‐risk patients after ileocecal resection for Crohn's disease. Patients' information about post‐operative risks remains an important issue. Risk factors for post‐operative morbidity despite faecal diversion are previous bowel resections.