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When should we add a diverting loop ileostomy to laparoscopic ileocolic resection for primary Crohn's disease?

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Abstract
Background The aims of this study were to determine risk factors for morbidity associated with laparoscopic ileocolic resection
(LICR) for Crohn’s disease (CD) and whether the addition of a diverting ileostomy is associated with reduced morbidity.
Methods Patients undergoing LICR for primary CD at our institution from 2005 to 2015 included in a prospectively maintained
database were assessed. The decision to perform a diverting ileostomy was left at the discretion of the operating
surgeon. Demographics, disease-related, and treatment-related variables were evaluated using univariate and multivariate
analyses as possible factors associated with diverting ileostomy creation and 30-day perioperative septic complications
(anastomotic leaks and/or abscess). Use of any immunosuppressive medication was defined as use of steroids, biologics,
and immunomodulators either alone or in combination.
Results For 409 patients, mortality was nil, overall morbidity rate was 40.6%, conversion rate 9.3%, and septic morbidity rate
7.6%. A diverting stoma was created in 22% of cases and was independently associated with BMI < 18.5 kg/m2 (P = 0.001),
low serum albumin levels (P = 0.006), and longer operative time (P = 0.003). Use of any immunosuppressive medication
was the only variable independently associated with septic complications, both in the overall population (OR 2.7, P = 0.036)
and in the subgroup of undiverted patients (OR 3.1, P = 0.031). There was no association between septic morbidity and
ileostomy creation, anastomotic configuration, penetrating disease, combined procedures (other resection or strictureplasty),
BMI, albumin levels, and operative times.
Conclusions LICR is safe in selected cases of complex penetrating disease, including when combined procedures are necessary.
Our data are unable to prove that a diverting stoma is associated with reduced morbidity.
Author(s)
윤용식Alexandra AielloConor P. DelaneyEmre GorgunLuca StocchiScott R. SteeleSherief ShawkiStefan HolubarTracy Hull
Issued Date
2021
Type
Article
Keyword
Crohn’s diseaseLaparoscopyOutcomesSurgeryTreatment
DOI
10.1007/s00464-020-07670-w
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7944
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2408205292&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,When%20should%20we%20add%20a%20diverting%20loop%20ileostomy%20to%20laparoscopic%20ileocolic%20resection%20for%20primary%20Crohn%27s%20disease%3F&amp;offset=0&amp;pcAvailability=true
Publisher
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES
Location
독일
Language
영어
ISSN
0930-2794
Citation Volume
35
Citation Number
6
Citation Start Page
2543
Citation End Page
2557
Appears in Collections:
Medicine > Medicine
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