Abstracts
2000 Digestive Disease Week

# 2238 Value of Stool Deviation in Surgery of Perianal Crohn’s Disease.
Frank Makowiec, Ulrich Adam, Ulrich T. Hopt, Michael Starlinger, Rostock, Germany, Tuebingen, Germany

In perianal Crohn’s disease (CD) stool deviation plays an important role in managing recurrent sepsis and for the healing after fistula repair. Under stoma coverage healing rates are high but data on the outcome after stoma closure are rare. We prospectively analyzed the clinical course in patients after perianal surgery under stoma coverage and after subsequent stoma closure. METHODS: Surgical therapy was performed in 31 patients under stoma coverage. 13 patients had drainage of perianal sepsis (catheter, seton) and 18 patients had flap repair (FR) of fistulas. Stoma closure was performed a median of 17 months (sepsis) and 7 months (FR) after surgery, respectively. Cumulative recurrence rates were calculated by lifetable-analysis. Median follow-up after stoma closure was 23 months. RESULTS: Abscess recurrence occured in 1 patient with a stoma and in 7 patients after stoma closure. Fistula recurrence after FR occured in 1 patient under stoma coverage and in 7 patients after stoma closure. After FR new fistulas (independent of the the operated fistula) occured in 1 patient under stoma coverage and in 5 patients after stoma closure. The actuarial recurrence rates before and after stoma closure are shown (table below): CONCLUSIONS: With a stoma recurrence of perianal CD is rare after surgery. After stoma closure recurrences and new fistulas occur frequently, as in patients without stool deviation. A temporary stoma does, therefore, not influence the natural course of perianal CD.