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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.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA

    Yong Sik Yoon, Stefan Holubar, Sherief Shawki, Emre Gorgun, Scott R. Steele, Conor P. Delaney & Tracy Hull

  2. Department of Colorectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea

    Yong Sik Yoon

  3. Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA

    Alexandra Aiello

  4. Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Desk A30, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Luca Stocchi

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  1. Yong Sik Yoon
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  2. Luca Stocchi
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Correspondence to Luca Stocchi.

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Disclosures

Dr Gorgun is a consultant for Boston Scientific and Lumendi. Dr Delaney has been a consultant for Takeda and Merck in 2018. Drs Yoon, Stocchi, Holubar, Aiello, Shawki, Steele, and Hull have no conflicts of interest or financial ties to disclose.

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Yoon, Y.S., Stocchi, L., Holubar, S. et al. When should we add a diverting loop ileostomy to laparoscopic ileocolic resection for primary Crohn’s disease?. Surg Endosc 35, 2543–2557 (2021). https://doi.org/10.1007/s00464-020-07670-w

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  • DOI: https://doi.org/10.1007/s00464-020-07670-w

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