Long-term results of faecal diversion for refractory perianal Crohn's disease

Faecal diversion (FD) for refractory anoperineal Crohn's disease (APCD) is thought to be unsatisfactory with a low overall rate of defunctioning stoma closure. However, only a few patients have so far been reported in the literature. The aim of this study was to reassess the long-term efficiency of FD for APCD.

Among 136 patients who were operated for APCD over a 18-year period, 17 underwent FD. The factors assessed were the mortality and morbidity of stoma formation, the evolution of anoperineal Crohn's disease after FD, and predictive factors of FD effectiveness.

Mean follow-up after FD was 135 +/- 79 months (range 20-328). Initial healing of APCD was observed in 11 patients (65%), allowing stoma closure after 14 +/- 9 months (range 3-52). The 6 other patients underwent abdominoperineal resection (APR) for persistent APCD. Three of the 11 patients with normal bowel continuity underwent secondary APR for APCD recurrence. Thus, at the end of follow up 9 (53%) patients had definitive end ileostomy and 8 (47%) continued to have normal bowel continuity with a mean follow up of 124 +/- 90 months (range 12-292) after stoma closure. The presence of rectal lesions at the time of FD was the only predictive factor of poor outcome: 8/9 (89%) patients with rectal lesions underwent APR vs 1/8 (13%) patients without rectal lesion (P < 0.01).

Faecal diversion for anoperineal Crohn's disease produced a high initial rate of anoperineal lesion healing. After long-term follow-up, results of faecal diversion are good (normal bowel continuity was restored in 89%) in patients without associated rectal lesions. However, in patients with associated rectal lesions, the prospects for restoring continuity were limited, thus making faecal diversion a questionable procedure.