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Ileostomy reversal after subtotal colectomy in Crohn's disease: a single institutional experience at a high-volume
Daniel Bitner1, Anthony D'Andrea2, Robert Grant2
1Department of Surgery, The Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA. bitner.daniel@gmail.com.
Purpose:
Our aim was to evaluate factors leading to ostomy reversal among a group of 44 patients with Crohn's disease (CD) who underwent subtotal colectomy (STC) between June 2011 and September 2018.
Methods:
Our study design was a retrospective chart review. Patients with CD who underwent STC were included. Logistic regression analysis was used to evaluate several risk factors for non-reversal including medications received prior to surgery and indication for STC.
Results:
Of 44 STCs performed, 31 (70.5%) were completed laparoscopically and 13 required an open approach (29.5%). Nine patients (20.4%) underwent ostomy reversal, and the mean time to reversal was 8.4 months. Preoperative therapy with an immunomodulator or biologic was associated with ostomy reversal (OR and CI: 0.43, 0.09-0.93; 0.47, 0.10-0.96), as was a diagnosis of intraabdominal abscess (0.43, 0.09-0.93).
Conclusion:
Ileostomy reversal after STC in Crohn's disease is uncommon. Certain treatment regimens and diagnostic factors may impact the likelihood of ostomy reversal. Based on the available data, patients with CD whose disease is severe enough to require STC should be counseled that their ostomy will most likely be permanent. However, due to the low incidence of this procedure for CD, more data is needed.
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