Abstract
ABSTRACT
Aim
Stoma creation is often required in Crohn's disease (CD), most commonly because of progressive anorectal disease. As stoma closure strongly influences long‐term quality of life and surgical decision‐making, this study evaluated the indications and long‐term outcomes of stoma creation in patients with CD.
Methods
A prospectively maintained database of CD patients who underwent surgery at Hyogo Medical University between 1974 and 2017 was retrospectively reviewed. Among 1440 surgically treated patients, 422 adults who required stoma creation for CD‐related indications were included. A permanent stoma was defined as resulting from abdominoperineal resection or remaining unclosed for more than 24 months. Permanent stoma‐free survival was estimated using the Kaplan–Meier method.
Results
Of the 422 patients, 107 (25%) had a permanent stoma at initial creation, whereas 315 (75%) received a temporary stoma. Among temporary stomas, 98 (31%) were closed, 133 (42%) remained unclosed, and 84 (27%) became permanent; 13 patients (13%) required re‐stoma creation after stoma closure. Anorectal disease was the most common indication (224 patients, 71%), followed by poor bowel condition (75 patients, 24%) and anastomotic leakage (14 patients, 4%). Closure rates were 13% for anorectal disease and 56% for poor bowel condition. Permanent stoma‐free survival was 94.8% at 10 years and 82.7% at 20 years; in patients treated after 2005, these rates improved to 95.9% and 86.5%, respectively (
p
= 0.032).
Conclusion
Among stomas created for Crohn's disease–related anorectal lesions, only 13% were successfully closed. These findings highlight the importance of achieving adequate disease control, including anorectal involvement, to avoid stoma creation.