FACTORS ASSOCIATED WITH LOOP ILEOSTOMY CREATION AT THE TIME OF ILEOCOLIC RESECTION WITH STAPLED END-TO-SIDE RECONSTRUCTION FOR CROHN'S DISEASE
Volkan Do?ru*1, Umut Akova1, Eren Esen1, Alton Sutter2, Emily M. Gardner2, Andre da Luz Moreira1, Arman Erkan1, John Kirat1, Michael J. Grieco1, Feza H. Remzi1, Jean Ashburn2
1Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY; 2Wake Forest Baptist Medical Center, Winston-Salem, NC
Introduction
Ileocecal resection (ICR) is a commonly performed operation for Crohn's Disease in patients with ileocolitis. Diverting loop ileostomy (DLI) creation is employed in selected patients to mitigate the sequelae of anastomotic leaks in those with higher risk anastomoses or less tolerance for complications. In our study, we sought to determine the most common factors associated with DLI after ICR for Crohn's disease.
Methods
Patients undergoing ICR with stapled end-to-side anastomosis reconstruction for Crohn' disease at two specialized Inflammatory Bowel Disease Centers between 2016-2021 were included. Factors influencing DLI creation were primarily investigated. Short-term postoperative outcomes were compared between those with and without DLI.
Results
Two hundred twenty patients were analyzed; 131 (60%) underwent concomitant DLI. Males (n=111) were more likely than females (n=109) to have DLI (71% vs 49%; p<0.001). Other factors associated with a higher likelihood for DLI were fistulizing disease (76% vs 43%; p<0.001), abscess formation (78% vs 49%; p<0.001) and fistulizing disease with an abscess (84% vs 49%; p<0.001). In multivariate analysis, fistulizing disease, abscess formation, disease duration in years and open surgery were associated risk factors for DLI creation (OR 3.09, 2.67, 1.04 and 2.49; 95% Cl 1.63-5.86, 1.33-5.35, 1.00-1.07 and 1.15-5.37, respectively). Unplanned 30-day reoperation rates were 2.3% vs. 2.2%, respectively for DLI and non-DLI groups (p=0.983) and 30-day readmissions were 27% vs 10%, respectively (p=0.003).
Conclusion
When performing ICR for Crohn's disease, surgeons were more likely to choose fecal diversion in the setting of higher-risk disease related factors (fistulizing disease, abscess formation, disease duration in years). When used thoughtfully, DLI may be utilized to reduce sequelae of post-operative complications in complex Crohn's patients after ICR resection.
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