Ileocolic resection with temporary ileostomy for Crohn's disease: does it affect long-term disease recurrence compared with primary anastomosis?

BACKGROUND

We aimed to assess whether the risk of disease recurrence in Crohn's disease (CD) patients that undergone ileocolic resection (ICR) with temporary ileostomy and a later stoma reversal is different compared to patients that underwent a one-stage operation.

METHODS

A single-center retrospective review of all patients that underwent elective primary ICR for CD between 2010 and 2022 divided into: 2S-ICR group-patients who underwent two-stage ICR. 1S-ICR group-patients who underwent one-stage ICR.

RESULTS

The cohort included 191 patients (mean age 33.4, range 15-70), with 40 and 151 patients in the 2S-ICR and 1S-ICR groups, respectively. The 2S-ICR were more comorbid, with a lower mean BMI (18 vs. 21.3, P < 0.001), higher median ASA score (3 vs. 2, P = 0.036), higher percentage on pre-operative total parenteral nutrition (TPN) (62.5% vs. 24.5%, P < 0.001), and lower levels of pre-operative albumin (3.3 g/dL vs. 3.8 g/dL, P < 0.001). There were no significant differences in the overall postoperative complication rate (47.5% vs. 47.7% respectively, P = 1), nor in the rate of severe complications (17.5% vs. 13.2%, P = 0.6), but, the 2S-ICR had a longer post-operative length-of-stay (14 vs. 6 days, P < 0.001) and higher rates of 30-day readmission (30% vs. 13.2%, P = 0.017). After an overall median follow-up of 63 months, the groups showed similar rates of endoscopic, clinical, and surgical recurrence.

CONCLUSIONS

Two-stage ICR with a temporary ileostomy does not change long-term CD recurrence rates compared with one-stage ICR.