¿Qué factores están asociados con la eventual necesidad de una ileostomía después de una colectomía abdominal total y una anastomosis ileosigmoidea o ileorrectal para la colitis de Crohn en la era biológica?

Translated title of the contribution: What factors are associated with the eventual need for an ileostomy after total abdominal colectomy and ileosigmoid or ileorectal anastomosis for Crohn's colitis in the biologic era?

Nicholas P. McKenna, Katherine A. Bews, Elizabeth B. Habermann, Eric J. Dozois, Amy L. Lightner, Kellie L. Mathis

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Outcomes after total abdominal colectomy with ileosigmoid or ileorectal anastomosis for Crohn's colitis and risk factors for requirement of a permanent ileostomy remain poorly understood, particularly in the biologic era. OBJECTIVE: This study aimed to determine long-term ostomy-free survival after ileosigmoid or ileorectal anastomosis for Crohn's colitis and potential risk factors for requirement of an ileostomy. DESIGN: This is a retrospective cohort study. SETTING: This study was conducted at a single-institution IBD tertiary referral center. PATIENTS: Patients diagnosed with Crohn's disease and undergoing ileosigmoid or ileorectal anastomosis between 2006 and 2018 were selected.

MAINOUTCOMEMEASURE: Long-term ostomy-free survival and hazard ratios of potential predictors of ileostomy requirement were the primary outcomes measured. RESULTS: One hundred nine patients (56% female) underwent ileosigmoid or ileorectal anastomosis for Crohn's disease. The majority of surgical procedures were completed in 2 or 3 stages (53%). The indication for total abdominal colectomy was predominantly medically refractory disease (77%), with dysplasia the second leading indication (13%). At an overall mean follow-up of 3 years, 16 patients had undergone either proctectomy or diversion with the rectum in situ. This resulted in ostomy-free survival estimates at 5 and 10 years of 78% (95% CI, 68-90) and 58% (95% CI, 35-94). A positive distal microscopic margin was the only risk factor for later requirement of a permanent ileostomy (HR, 5.4; 95% CI, 1.7-17.2). LIMITATIONS: This study is limited because it is a retrospective study at a tertiary referral center. CONCLUSIONS: Long-term ostomy-free survival can be achieved in the majority of patients who undergo restoration of intestinal continuity after total abdominal colectomy for Crohn's colitis. A positive distal microscopic margin was independently associated with long-term anastomotic failure, and it should be accounted for when risk stratifying patients for postoperative prophylactic medical therapy.

Translated title of the contributionWhat factors are associated with the eventual need for an ileostomy after total abdominal colectomy and ileosigmoid or ileorectal anastomosis for Crohn's colitis in the biologic era?
Original languageSpanish
Pages (from-to)504-513
Number of pages10
JournalDiseases of the colon and rectum
DOIs
StatePublished - Apr 1 2020

Keywords

  • Crohn's disease
  • Ileorectal anastomosis
  • Ileosigmoid anastomosis
  • Ostomy

ASJC Scopus subject areas

  • Gastroenterology

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