P653 Impact of ileostomy on recurrence rate after ileo-colic resection for Crohn’s disease: A critical appraisal from a referral centre

Abstract

Post-operative recurrence after ileo-colic resection for Crohn's disease (CD) is somehow inevitable. Several studies investigated risk factors for recurrent disease. The introduction of laparoscopic surgery for CD has improved the quality of life of patients undergoing ileo-colic resection, however the need for protective ileostomy has remained substantially unchanged. Ileostomy diverts the stools before the anastomosis, and could potentially have a role in the disease relapse. Aim of the study was to correlate the presence of a protective ileostomy with the postoperative recurrence rate after ileo-colic resection for CD. All the patients who underwent ileo-colic resection for CD from 2008 onwards have been prospectively enrolled. Patients who had a so-called “protective” ileostomy or those requiring a postoperative ileostomy due to complications, were retrieved from the database and endoscopic recurrence in 1 and 3 years after surgery was compared with patients who did not receive any diversion. Other risk factors for recurrent disease were also considered. Recurrence was assessed through ileocolonoscopy and classified by the Rutgeerts scoring system. Chi-square and t Student tests were used for statistical analysis. Twenty out of 185 patients who underwent ileo-colic resection for CD, received an ileostomy (16 “protective” ileostomies and 4 for postoperative complications.). Endoscopy was performed in 166 patients at 1 year and in 115 patients at 3 years after surgery. Endoscopic recurrence (assessed as a Rutgeerts score > 2) was found in 25% of patients who had an ileostomy vs. 86% of those without ileostomy at 1 year (p < 0.03) and in 54% vs. 88% at 3 years (p < 0.04). Patients underwent closure of ileostomies from 1 to 5 months (3 months on average) away from surgery, with no major complications. The presence of an ileostomy in our CD patients undergoing ileo-colic resection appeared to represent a protective factor for post-operative endoscopic recurrence both at 1 and 3 years from surgery. Although the main bias represented by the limited number of patients treated with ileostomy, this result seems worthy of further investigation to better understand a possible role of intestinal diversion in CD recurrence.