Otten, A.T. (2019) Therapeutic benefits of a diverting stoma on the surgical course of Crohn’s colitis. thesis, Medicine.
Full text available on request.Abstract
Objectives To determine if redirection of the fecal stream away from the colon, by means of diverting stoma placement, in patients with refractory Crohn’s colitis can lead to successful and lasting stoma reversal and the prevention of colorectal resections. Methods This retrospective cohort study was performed by examining data from three hospitals in the Netherlands regarding patients with Crohn’s colitis who underwent diverting stoma placement. Primary outcomes were stoma reversal with restoration of bowel continuity and the need for colorectal resections. Results 24 patients with medical therapy refractory Crohn’s colitis who underwent placement of a diverting stoma were included. Reduction of clinical symptoms was found in 83% of patients, 42% of these patients even achieved complete clinical remission. Stoma reversal was performed in 54% of patients at median of 1.04 years, in 63% stoma reversal was accomponied by a partial colorectal resection. After a median follow-up of 3,9 years, 77% of patient with restoration of continuity remained stoma free. Fecal diversion led to a reduction of the extension of colorectal resection in 25% of patients and resection was entirely avoided in 33% of patients. Crohn’s colitis with rectal inflammation had a lower succesful stoma reversal rate (15%, p=0,007). Conclusion A diverting stoma reduces symptoms in 83% of the patients with Crohn’s colitis. Continuity can be restored in 54% of all patients and in 15% of patients with rectal involvement. After stoma reversal, 78% of patients were able to remain stoma free. Colorectal resections can be reduced or avoided in respectively 25% and 33% of the patients. Therefore, in patients with an isolated Crohn’s colitis without rectal involvement, a diverting stoma is a considerable alternative to avoid a permanent stoma and large colorectal resections.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Dijkstra, Prof Dr. G. Gastro-enterologist and Second supervisor: and Loo, Dr. E.S. van GSurgeon Departments: Gastroenterology an |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:51 |
| Last Modified: | 25 Jun 2020 10:51 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1229 |
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