Perrott Claire, Calini Giacomo, Gori Alice, Rottoli Matteo, Flacco Maria E, Manzoli Lamberto, Garoufalia Zoe, Wexner Steven D, Kontovounisios Christos, Elhadi Muhammed, Celentano Valerio
Inflammatory Bowel Disease and Ileoanal Pouch Surgery Centre, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
ClinicaChirurgica, University Hospital of Udine, Udine, Italy.
BJS Open. 2025 May 7;9(3). doi: 10.1093/bjsopen/zraf010.
Patients with ileocolic Crohn's disease often require surgery that can result in temporary stoma formation. Stomas are associated with a morbidity and can negatively impact quality of life. This study aimed to investigate the short-term (6-month) and mid-term (18-month) outcomes of intended temporary stomas in patients with Crohn's disease.
A trainee-led, international multicentre, retrospective study was conducted on all patients who underwent surgery for Crohn's disease in collaborating centres over 4 years (2017-2020). The primary outcome was the proportion of patients with Crohn's disease who underwent stoma reversal surgery by 6- and 18-month postoperative follow-up. Secondary outcomes included: the time interval between formation and reversal of stoma and predictors for non-reversal and stoma-related morbidity (postoperative complications, related readmissions and complications due to stoma reversal surgery).
A total of 401 patients underwent stoma formation for Crohn's disease over the 4 years across the 44 collaborating centres. The temporary stomas had been reversed in 30.2% of patients at the 6-month and 56.9% at the 18-month follow-up. Reasons for non-reversal included ongoing medical treatment for Crohn's disease (respectively 6-month and 18-month: 37.6%, 39.3%), patient unfit for surgery (respectively 6-month and 18-month: 14.5%, 16.8%), patient preference (respectively 6-month and 18-month: 12.1%, 20.2%) and due to waiting lists (respectively 6-month and 18-month: 12.1%, 8.1%). Overall, 63.3% of patients had a temporary stoma reversed with a median time interval of 6 months. The stoma-related overall morbidity rate was 29.4%.
A large proportion of temporary stomas for Crohn's disease were not reversed at 6 and 18 months following initial surgery. Patients are exposed to the risk of non-reversal and risk of developing stoma complications for significantly longer intervals of time and, in some cases, indefinitely.
回结肠型克罗恩病患者常需接受手术，这可能导致临时造口的形成。造口与发病率相关，会对生活质量产生负面影响。本研究旨在调查克罗恩病患者预期临时造口的短期（6个月）和中期（18个月）结局。
在4年（2017 - 2020年）期间，对协作中心所有因克罗恩病接受手术的患者进行了一项由实习生主导的国际多中心回顾性研究。主要结局是术后6个月和18个月随访时接受造口回纳手术的克罗恩病患者比例。次要结局包括：造口形成与回纳之间的时间间隔以及未回纳和造口相关发病率的预测因素（术后并发症、相关再入院以及造口回纳手术引起的并发症）。
在4年时间里，44个协作中心共有401例患者因克罗恩病接受了造口术。在6个月随访时，30.2%的患者临时造口已回纳，18个月随访时这一比例为56.9%。未回纳的原因包括持续的克罗恩病治疗（6个月和18个月时分别为37.6%、39.3%）、患者不适合手术（6个月和18个月时分别为14.5%、16.8%）、患者偏好（6个月和18个月时分别为12.1%、20.2%）以及由于等候名单（6个月和18个月时分别为12.1%、8.1%）。总体而言，63.3%的患者临时造口已回纳，中位时间间隔为6个月。造口相关的总体发病率为29.4%。
初次手术后6个月和18个月时，很大一部分克罗恩病临时造口未回纳。患者面临造口未回纳的风险以及在更长时间内（在某些情况下是无限期）发生造口并发症的风险。
