Reversal Surgery for Split Stoma with Peristomal Incision is Associated with Improved Postoperative Outcome in Patients with Crohn’s Disease

Figures & data

Figure 1. A flowchart of the inclusion process for patients with CD. A total of 255 patients who met the inclusion criteria were enrolled in the study.

Figure 2. Preoperative, intraoperative and postoperative pictures (I, II, and III) of stoma reversal surgery. (A) The end stoma closer (ESC). (B) The split stoma reversal (SSR).

Table 1. Demographic and disease characteristics of 255 patients with CD who underwent stoma reversal surgery.

Patients’ characteristics	ESC (192)	SSR (63)	p
Age at operation, median (IQR)	35 (28.0–45.0)	32 (26.0–44.0)	0.37
Duration disease (years), median (IQR)	5 (2.0–10.0)	3 (2.0–7.0)	0.02
Gender			0.68
Male, n (%)	135 (70.3)	46 (73.0)
Female, n (%)	57 (29.7)	17 (27.0)
Age at diagnosis			0.91
A1 (<17), n (%)	16 (8.3)	5 (7.9)
A2 (17–40), n (%)	135 (70.3)	46 (73.0)
A3 (>40), n (%)	41 (21.4)	12 (19.1)
Disease location			0.48
L1, n (%)	62 (32.3)	25 (39.7)
L2, n (%)	19 (9.9)	7 (11.1)
L3, n (%)	111 (57.8)	31 (49.2)
Disease behavior			0.11
B1, n (%)	6 (3.1)	2 (3.2)
B2, n (%)	42 (21.9)	22 (34.9)
B3, n (%)	144 (75.0)	39 (61.9)
Upper digestive tract disease, n (%)	6 (3.1)	3 (4.8)	0.83
Perianal disease history, n (%)	42 (21.9)	20 (31.7)	0.11
Smoking, n (%)	6 (3.0)	3 (4.8)	0.83
Appendectomy history, n (%)	32 (16.7)	10 (15.9)	0.88
BMI, median (IQR)	18.9 (17.0–20.8)	18.9 (17.6–21.5)	0.35
Preoperative medication history
Immunosuppressor, n (%)	50 (26.0)	24 (38.1)	0.07
Anti-TNF therapy, n (%)	72 (37.5)	29 (46.0)	0.23
Perioperative blood test parameters
Alb (g/L), median (IQR)	41.5 (38.0–44.5)	42.2 (39.5–45.3)	0.07
CRP (mg/L), median (IQR)	0.8 (0.5–2.8)	0.6 (0.5–1.7)	0.28
ESR (mm/h), median (IQR)	9.0 (5.0–16.0)	9.0 (5.0–14.0)	0.71
FC (mg/L), median (IQR)	40.8 (16.0–108.9)	45.9 (12.4–97.0)	0.70
Short bowel syndrome, n (%)	12 (6.3)	4 (6.3)	>0.99
Ostomy complications, n (%)	7 (3.6)	5 (7.9)	0.29
Intervals between stoma formation and closure (months), median (IQR)	7.9 (5.8–12.0)	6.2 (4.8–8.7)	0.001
Postoperative follow-up time (months), median (IQR)	40 (23.0–55.0)	36 (24.0–59.0)	0.33

Abbreviations: ESC, end stoma closer; SSR, split stoma reversal; CD, Crohn’s disease; B1, nonstricturing nonpenetrating; B2, stricturing; B3, penetrating; BMI, body mass index; Anti-TNF, anti-tumor necrosis factor; Alb, albumin; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; FC, fecal calprotectin.

Table 2. Surgical information of 255 patients with CD who underwent stoma reversal surgery.

Patients’ characteristics	ESC (192)	SSR (63)	p
Operative time (minutes), median (IQR)	120.0 (100.0–145.0)	80.0 (65.0–95.0)	0.0004
Intraoperative blood loss volume (ml), median (IQR)	100.0 (50.0–150.0)	20.0 (10.0–50.0)	0.0002
Intraoperative blood transfusion, n (%)	3 (1.6)	0	>0.99
Incision length (cm), median (IQR)	15.0 (15.0–18.0)	3.0 (3.0–3.0)	<0.0001
Surgical wound classification			0.04
II, n (%)	176 (91.7)	63 (100)
III, n (%)	16 (8.3)	0

Abbreviations: ESC, end stoma closer; SSR, split stoma reversal; CD, Crohn’s disease.

Figure 3. The Kaplan–Meier curve of patients (SSR vs. ESC) during follow-up.

Table 3. Postoperative outcomes of 255 patients with CD who underwent stoma reversal surgery.

Patients’ characteristics	ESC (192)	SSR (63)	p
Postoperative hospital stay (days), median (IQR)	9.0 (7.0–13.0)	7.0 (5.0–10.0)	0.0007
Hospital expense (1,000 yuan), median (IQR)	54.2 (46.9–62.3)	45.6 (38.2–53.4)	0.0003
Postoperative complications, n (%)	85 (44.3)	15 (23.8)	0.0040
Ileus, n (%)	32 (16.7)	7 (11.1)	0.29
Surgical site infection, n (%)	16 (8.3)	2 (3.1)	0.27
Ascites, n (%)	8 (4.1)	1 (1.6)	0.57
Diarrhea, n (%)	12 (6.3)	2 (3.2)	0.54
Others, n (%)	17 (8.9)	3 (4.8)	0.29
Complications of II and above, n (%)	36 (18.8)	9 (14.3)	0.42

Abbreviations: ESC, end stoma closer; SSR, split stoma reversal; CD, Crohn’s disease.

Data availability statement

The database is available if properly requested and can be directly addressed to the corresponding author’s email address.