Patients with Crohn’s disease have a higher failure rate after ileal pouch surgery compared with their counterparts with ulcerative colitis.
Dr Erman Aytac and colleagues hypothesized that risk of continent ileostomy failure can be stratified based on the timing of Crohn’s disease diagnosis and aimed to assess long-term outcomes.
The research team performed a retrospective cohort study.
The investigation took place in a high-volume, specialized colorectal surgery department.
The researchers evaluated patients with Crohn’s disease who underwent continent ileostomy surgery between 1978 and 2013.
The team's main outcomes includedd functional outcomes, postoperative complications, requirement of revision surgery, and continent ileostomy failure.
|Major revisions were performed in 83%|
|Diseases of the Colon & Rectum|
There were 48 patients with a median age of 33 years at the time of continent ileostomy creation.
Crohn’s disease diagnosis was before continent ileostomy (intentional) in 15 or made in a delayed fashion at a median 4 years after continent ileostomy in 33 patients.
Median follow-up was 19 years after index continent ileostomy creation.
The research team found that major and minor revisions were performed in 83%, and 27% of patients.
Complications were fistula, pouchitis, valve slippage, hernia, afferent limb stricture, difficult intubation, incontinence, bowel obstruction, valve stricture, leakage, bleeding, and valve prolapse.
The team noted that the median Cleveland global quality-of-life score was 0.8.
Continent ileostomy failure occurred in 46% of patients.
The researchers found that continent ileostomy survival was 48% at 20 years.
The research team noted that continent ileostomy failure was similar regardless of timing of diagnosis of Crohn’s disease.
Dr Aytac's team concludes, "Outcomes of continent ileostomy in patients with Crohn’s disease are poor, regardless of the timing of diagnosis."
"Very careful consideration should be given by both the surgeon and the patient before undertaking this procedure in patients with Crohn’s disease."