The role of a defunctioning stoma for colonic and perianal Crohn’s disease in the biological era

AbstractObjective: A defunctioning stoma is a therapeutic option for colonic or perianal Crohn’s disease. In the pre-biologic era the response rate to defunctioning in our unit was high (86%), but intestinal continuity was only restored in 11–20%. Few data exist on the outcome of defunctioning since the widespread introduction of biologicals.Material and methods: All patients undergoing a defunctioning stoma for colonic/perianal Crohn’s disease since 2003–2011 were identified from a prospective database. Indications for surgery, medical therapy, response to defunctioning and long-term clinical outcome were recorded. Successful restoration of continuity was defined as no stoma at last follow up.Results: Seventy-six patients were defunctioned (57 with biologicals) and at last follow up, 20 (27%) had continuity restored. Early clinical response rate (<3 months) was 15/76 (20%) and overall response 31/76 (41%). Complex anal fistulae/stenosis were associated with a very low chance of restoring continuity (10% ...