Ileocolic resection with temporary ileostomy for Crohn's disease: does it affect long-term disease recurrence compared with primary anastomosis?

Background: We aimed to assess whether the risk of disease recurrence in Crohn's disease (CD) patients that undergone ileocolic resection (ICR) with temporary ileostomy and a later stoma reversal is different compared to patients that underwent a one-stage operation.

Methods: A single-center retrospective review of all patients that underwent elective primary ICR for CD between 2010 and 2022 divided into: 2S-ICR group-patients who underwent two-stage ICR. 1S-ICR group-patients who underwent one-stage ICR.

Results: The cohort included 191 patients (mean age 33.4, range 15-70), with 40 and 151 patients in the 2S-ICR and 1S-ICR groups, respectively. The 2S-ICR were more comorbid, with a lower mean BMI (18 vs. 21.3, P < 0.001), higher median ASA score (3 vs. 2, P = 0.036), higher percentage on pre-operative total parenteral nutrition (TPN) (62.5% vs. 24.5%, P < 0.001), and lower levels of pre-operative albumin (3.3 g/dL vs. 3.8 g/dL, P < 0.001). There were no significant differences in the overall postoperative complication rate (47.5% vs. 47.7% respectively, P = 1), nor in the rate of severe complications (17.5% vs. 13.2%, P = 0.6), but, the 2S-ICR had a longer post-operative length-of-stay (14 vs. 6 days, P < 0.001) and higher rates of 30-day readmission (30% vs. 13.2%, P = 0.017). After an overall median follow-up of 63 months, the groups showed similar rates of endoscopic, clinical, and surgical recurrence.

Conclusions: Two-stage ICR with a temporary ileostomy does not change long-term CD recurrence rates compared with one-stage ICR.