What is the rate of definitive stoma after subtotal colectomy for inflammatory bowel disease? A nationwide study of 1860 patients.
Crohn's disease
definitive stoma
ulcerative colitis
Journal
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
ISSN: 1463-1318
Titre abrégé: Colorectal Dis
Pays: England
ID NLM: 100883611
Informations de publication
Date de publication:
16 May 2024
16 May 2024
Historique:
revised:
23
02
2024
received:
08
12
2023
accepted:
28
04
2024
medline:
17
5
2024
pubmed:
17
5
2024
entrez:
17
5
2024
Statut:
aheadofprint
Résumé
Some patients with inflammatory bowel disease (IBD) require subtotal colectomy (STC) with ileostomy. The recent literature reports a significant number of patients who do not undergo subsequent surgery and are resigned to living with a definitive stoma. The aim of this work was to analyse the rate of definitive stoma and the cumulative incidence of secondary reconstructive surgery after STC for IBD in a large national cohort study. A national retrospective study (2013-2021) was conducted on prospectively collected data from the French Medical Information System Database (PMSI). All patients undergoing STC in France were included. The association between definitive stoma and potential risk factors was studied using univariate and multivariate analyses. A total of 1860 patients were included (age 45 ± 9 years; median follow-up 30 months). Of these, 77% (n = 1442) presented with ulcerative colitis. Mortality and morbidity at 90 days after STC were 5% (n = 100) and 47% (n = 868), respectively. Reconstructive surgery was identified in 1255 patients (67%) at a mean interval of 7 months from STC. Seveny-four per cent (n = 932) underwent a completion proctectomy with ileal pouch anal anastomosis and 26% (n = 323) an ileorectal anastomosis. Six hundred and five (33%) patients with a definitive stoma had an abdominoperineal resection (n = 114; 19%) or did not have any further surgical procedure (n = 491; 81%). Independent risk factors for definitive stoma identified in multivariate analysis were older age, Crohn's disease, colorectal neoplasia, postoperative complication after STC, laparotomy and a low-volume hospital. We found that 33% of patients undergoing STC with ileostomy for IBD had definitive stoma. Modifiable risk factors for definitive stoma were laparotomy and a low-volume hospital.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Investigateurs
Lionel Arrivé
(L)
Laurent Beaugerie
(L)
Anne Bourrier
(A)
Marine Camus
(M)
Najim Chafai
(N)
Edouard Chambenois
(E)
Ulriikka Chaput
(U)
Clotilde Debove
(C)
Charlotte Delattre
(C)
Xavier Dray
(X)
Jean-François Fléjou
(JF)
Guillaume Le Gall
(G)
Nadia Hoyeau
(N)
Julien Kirchgesner
(J)
Cécilia Landman
(C)
Jérémie H Lefèvre
(JH)
Philippe Marteau
(P)
Chloé Martineau
(C)
Laurence Monnier-Cholley
(L)
Isabelle Nion-Larmurier
(I)
Violaine Ozenne
(V)
Yann Parc
(Y)
Philippe Seksik
(P)
Magali Svrcek
(M)
Informations de copyright
© 2024 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.
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