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PMID- 28383450
DA  - 20170406
DCOM- 20170418
LR  - 20170418
IS  - 1530-0358 (Electronic)
IS  - 0012-3706 (Linking)
VI  - 60
IP  - 5
DP  - 2017 May
TI  - Long-term Outcomes After Continent Ileostomy Creation in Patients With Crohn's
PG  - 508-513
LID - 10.1097/DCR.0000000000000815 [doi]
AB  - BACKGROUND: Patients with Crohn's disease have a higher failure rate after ileal 
      pouch surgery compared with their counterparts with ulcerative colitis.
      OBJECTIVE: We hypothesized that risk of continent ileostomy failure can be
      stratified based on the timing of Crohn's disease diagnosis and aimed to assess
      long-term outcomes. DESIGN: This was a retrospective cohort study. SETTINGS: The 
      investigation took place in a high-volume, specialized colorectal surgery
      department. PATIENTS: Patients with Crohn's disease who underwent continent
      ileostomy surgery between 1978 and 2013 were evaluated. MAIN OUTCOME MEASURES:
      Functional outcomes, postoperative complications, requirement of revision
      surgery, and continent ileostomy failure were analyzed. RESULTS: There were 48
      patients (14 male patients) with a median age of 33 years at the time of
      continent ileostomy creation. Crohn's disease diagnosis was before continent
      ileostomy (intentional) in 15 or made in a delayed fashion at a median 4 years
      after continent ileostomy in 33 patients. Median follow-up was 19 years (range,
      1-33 y) after index continent ileostomy creation. Major and minor revisions were 
      performed in 40 (83%) and 13 patients (27%). Complications were fistula (n = 20),
      pouchitis (n = 16), valve slippage (n = 15), hernia (n = 9), afferent limb
      stricture (n = 9), difficult intubation (n = 8), incontinence (n = 7), bowel
      obstruction (n = 7), valve stricture (n = 5), leakage (n = 4), bleeding (n = 3), 
      and valve prolapse (n = 3). Median Cleveland global quality-of-life score was
      0.8. Continent ileostomy failure occurred in 22 patients (46%). Based on
      Kaplan-Meier estimates, continent ileostomy survival was 48 % (95% CI, 33%-63%)
      at 20 years. Continent ileostomy failure was similar regardless of timing of
      diagnosis of Crohn's disease (p = 0.533). LIMITATIONS: This study was limited by 
      its retrospective and nonrandomized nature. CONCLUSIONS: Outcomes of continent
      ileostomy in patients with Crohn's disease are poor, regardless of the timing of 
      diagnosis. Very careful consideration should be given by both the surgeon and the
      patient before undertaking this procedure in patients with Crohn's disease. See
      Video Abstract at
FAU - Aytac, Erman
AU  - Aytac E
AD  - Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 
      Cleveland, Ohio.
FAU - Dietz, David W
AU  - Dietz DW
FAU - Ashburn, Jean
AU  - Ashburn J
FAU - Remzi, Feza H
AU  - Remzi FH
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Dis Colon Rectum
JT  - Diseases of the colon and rectum
JID - 0372764
SB  - IM
MH  - Adult
MH  - *Crohn Disease/diagnosis/epidemiology/physiopathology/surgery
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - *Ileostomy/adverse effects/methods
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Ohio/epidemiology
MH  - Outcome and Process Assessment (Health Care)
MH  - *Postoperative Complications/etiology/mortality/psychology/surgery
MH  - *Proctocolectomy, Restorative/adverse effects/methods
MH  - *Quality of Life
MH  - *Reoperation/methods/statistics & numerical data
MH  - Retrospective Studies
EDAT- 2017/04/07 06:00
MHDA- 2017/04/19 06:00
CRDT- 2017/04/07 06:00
AID - 10.1097/DCR.0000000000000815 [doi]
AID - 00003453-201705000-00007 [pii]
PST - ppublish
SO  - Dis Colon Rectum. 2017 May;60(5):508-513. doi: 10.1097/DCR.0000000000000815.

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