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Crohn Disease: HELP
Articles by Feza H. Remzi
Based on 48 articles published since 2010
(Why 48 articles?)
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Between 2010 and 2020, F. Remzi wrote the following 48 articles about Crohn Disease.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial Laparoscopic surgery for complex and recurrent Crohn's disease. 2017

Sevim, Yusuf / Akyol, Cihangir / Aytac, Erman / Baca, Bilgi / Bulut, Orhan / Remzi, Feza H. ·Yusuf Sevim, Department of General Surgery, Kayseri Training and Research Hospital, Kayseri 38110, Turkey. ·World J Gastrointest Endosc · Pubmed #28465780.

ABSTRACT: Crohn's disease (CD) is a chronic inflammatory disease of digestive tract. Approximately 70% of patients with CD require surgical intervention within 10 years of their initial diagnosis, despite advanced medical treatment alternatives including biologics, immune suppressive drugs and steroids. Refractory to medical treatment in CD patients is the common indication for surgery. Unfortunately, surgery cannot cure the disease. Minimally invasive treatment modalities can be suitable for CD patients due to the benign nature of the disease especially at the time of index surgery. However, laparoscopic management in fistulizing or recurrent disease is controversial. Intractable fibrotic strictures with obstruction, fistulas with abscess formation and hemorrhage are the surgical indications of recurrent CD, which are also complicating laparoscopic treatments. Nevertheless, laparoscopy can be performed in selected CD patients with safety, and may provide better outcomes compared to open surgery. The common complication after laparoscopic intervention is postoperative ileus seems and this may strongly relate excessive manipulation of the bowel during dissection. But additionally, unsuccessful laparoscopic attempts requiring conversion to open surgery have been a major concern due to presumed risk of worse outcomes. However, recent data show that conversions do not to worsen the outcomes of colorectal surgery in experienced hands. In conclusion, laparoscopic treatment modalities in recurrent CD patients have promising outcomes when it is used selectively.

2 Review The Role of Laparoscopic, Robotic, and Open Surgery in Uncomplicated and Complicated Inflammatory Bowel Disease. 2019

Schwartzberg, David M / Remzi, Feza H. ·Department of Surgery, Inflammatory Bowel Disease Center, New York University Langone Health, 240 East 38th Street, 23rd Floor, New York, NY 20016, USA. · Department of Surgery, Inflammatory Bowel Disease Center, New York University Langone Health, 240 East 38th Street, 23rd Floor, New York, NY 20016, USA. Electronic address: Feza.Remzi@NYULangone.Org. ·Gastrointest Endosc Clin N Am · Pubmed #31078253.

ABSTRACT: The incidence of inflammatory bowel disease is increasing and despite advances in medical therapy, patients continue to require operations for complications of their disease. Minimally invasive surgical options have impacted postoperative morbidity dramatically with reduction of pain, length of stay and adhesion formation, but additionally, this population of patients are not only concerned with successful operative therapy but also the ability to return to their lifestyle and cosmetics. Laparoscopic and robotic surgery for Crohn's disease has proven to benefit patients with ileocolic or colonic disease, however complicated disease with phlegmon, abscess or fistulae is best served with a hybrid approach. Ulcerative colitis treatment has seen advancements with laparoscopic and robotic platforms, however the benefits of minimally invasive surgery must be balanced with producible and durable outcomes.

3 Review Canadian Association of General Surgeons, the American College of Surgeons, the Canadian Society of Colorectal Surgeons and the American Society of Colorectal Surgeons Evidence Based Reviews in Surgery - colorectal surgery. 2014

Brown, Carl J / Achkar, Jean-Paul / Bressler, Brian L / Maclean, Anthony R / Remzi, Feza H / Anonymous360781. · ·Dis Colon Rectum · Pubmed #24401893.

ABSTRACT: -- No abstract --

4 Review Crohn's disease complicated by strictures: a systematic review. 2013

Rieder, Florian / Zimmermann, Ellen M / Remzi, Feza H / Sandborn, William J. ·Department of Pathobiology, Lerner Research Institute, NC22, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. riederf@ccf.org ·Gut · Pubmed #23626373.

ABSTRACT: The occurrence of strictures as a complication of Crohn's disease is a significant clinical problem. No specific antifibrotic therapies are available. This systematic review comprehensively addresses the pathogenesis, epidemiology, prediction, diagnosis and therapy of this disease complication. We also provide specific recommendations for clinical practice and summarise areas that require future investigation.

5 Article Alvimopan for the Prevention of Postoperative Ileus in Inflammatory Bowel Disease Patients. 2020

Jang, Janice / Kwok, Benjamin / Zhong, Hua / Xia, Yuhe / Grucela, Alexis / Bernstein, Mitchell / Remzi, Feza / Hudesman, David / Chen, Jingjing / Axelrad, Jordan / Chang, Shannon. ·Division of Gastroenterology and Hepatology, New York University Langone Health, 240 East 38th Street, 23rd Floor, New York, NY, 10016, USA. · Department of Internal Medicine, New York University Langone Health, New York, NY, USA. · Department of Population Health, New York University Langone Health, New York, NY, USA. · Department of Surgery, New York University Langone Health, New York, NY, USA. · Department of Internal Medicine, Stanford University Medical Center, Stanford, CA, USA. · Division of Gastroenterology and Hepatology, New York University Langone Health, 240 East 38th Street, 23rd Floor, New York, NY, 10016, USA. Shannon.Chang@nyulangone.org. ·Dig Dis Sci · Pubmed #31522323.

ABSTRACT: BACKGROUND: Postoperative ileus (POI) is a temporary delay of coordinated intestinal peristalsis. Alvimopan, an oral peripherally acting mu-opioid receptor antagonist approved for accelerating gastrointestinal recovery, has never been studied specifically in patients with inflammatory bowel disease (IBD). AIM: To investigate the efficacy of alvimopan in preventing POI among IBD patients. METHODS: A retrospective chart review was conducted on 246 IBD patients undergoing bowel surgery between 2012 and 2017. Data collected included demographics, IBD subtype, length of stay (LOS), postoperative gastrointestinal symptoms, and administration of alvimopan. The primary outcome was POI; secondary gastrointestinal recovery outcomes were: time to first flatus, time to first bowel movement, time to tolerating a liquid diet, time to tolerating solid food, and LOS. RESULTS: When compared with the control group, patients in the alvimopan group had shorter times to tolerating liquids and solids, first flatus, and first bowel movements (p < 0.01). LOS was shorter in the alvimopan group when compared with controls (p < 0.01). The overall incidence of POI was higher in controls than in the alvimopan group (p = 0.07). For laparoscopic surgeries, the incidence of POI was also higher in controls than in the alvimopan group (p < 0.01). On multivariable analysis, alvimopan significantly decreased time to all gastrointestinal recovery endpoints when compared to controls (p < 0.01). CONCLUSIONS: Alvimopan is effective in accelerating time to gastrointestinal recovery and reducing POI in IBD patients. While the benefits of alvimopan have been demonstrated previously, this is the first study of the efficacy of alvimopan in IBD patients.

6 Article Is Conversion of a Failed IPAA to a Continent Ileostomy a Risk Factor for Long-term Failure? 2019

Aytac, Erman / Dietz, David W / Ashburn, Jean / Remzi, Feza H. ·Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio. · Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey. · Division of Colorectal Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio. · Department of General Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina. · Division of Colorectal Surgery, Department of Surgery, New York University, Langone Medical Center, New York, New York. ·Dis Colon Rectum · Pubmed #30451753.

ABSTRACT: BACKGROUND: A continent ileostomy may be offered to patients in hopes of avoiding permanent ileostomy. Data on the outcomes of continent ileostomy patients with a history of a failed IPAA are limited. OBJECTIVE: This study aimed to assess whether a history of previous failed IPAA had an effect on continent ileostomy survival and the long-term outcomes. DESIGN: This was a retrospective cohort study. SETTINGS: This investigation took place in a high-volume, specialized colorectal surgery department. PATIENTS: Patients who underwent continent ileostomy construction after IPAA failure between 1982 and 2013 were evaluated and compared with patients who have no history of IPAA surgery. MAIN OUTCOME MEASURES: Functional outcomes and long-term complications were compared. RESULTS: A total of 67 patients fulfilled the case-matching criteria and were included in the analysis. Requirement of major (52% vs 61%; p = 0.756) and minor (15% vs 19%; p = 0.492) revisions were comparable between patients who had continent ileostomy after a failed IPAA and those who had continent ileostomy without having a previous restorative procedure. Intubations per day (5 vs 5; p = 0.804) and per night (1 vs 1; p = 0.700) were similar in both groups. Our data show no clear relationship between failure of continent ileostomy and history of failed IPAA (p = 0.638). The most common cause of continent ileostomy failure was enterocutaneous/enteroenteric fistula (n = 14). Six patients died during the study period because of other causes unrelated to continent ileostomy. LIMITATIONS: This study was limited by its retrospective and nonrandomized nature. CONCLUSIONS: Converting a failed IPAA to a continent ileostomy did not worsen continent ileostomy outcomes in this selected group of patients. When a redo IPAA is not feasible, continent ileostomy can be offered as an alternative to conventional end ileostomy in highly motivated patients. See Video Abstract at http://links.lww.com/DCR/A803.

7 Article Factors Associated with Short-Term Morbidity in Patients Undergoing Colon Resection for Crohn's Disease. 2018

Aydinli, H Hande / Aytac, Erman / Remzi, Feza H / Bernstein, Mitchell / Grucela, Alexis L. ·Department of Surgery, Division of Colon and Rectal Surgery, Department of Colorectal Surgery, New York University Langone Medical Center, 530 First Ave Suite 7V, New York, NY, 10016, USA. · Department of Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey. · Department of Surgery, Division of Colon and Rectal Surgery, Department of Colorectal Surgery, New York University Langone Medical Center, 530 First Ave Suite 7V, New York, NY, 10016, USA. Alexis.Grucela@nyumc.org. ·J Gastrointest Surg · Pubmed #29663305.

ABSTRACT: BACKGROUND: Patients undergoing colon resection for Crohn's disease are at risk of developing postoperative complications. The aim of this study is to identify factors associated with short-term (30-day) morbidity in patients undergoing colon resection for Crohn's disease from a national database. METHODS: Patients who underwent colon resection for Crohn's disease in 2015 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. The groups were classified based on presence of postoperative 30-day complications. The overall morbidity was calculated by including patients who had at least one postoperative complication. Demographics, preoperative, and operative factors were assessed and compared between the two groups. Further multivariate logistic regression analysis was conducted. RESULTS: A total of 1643 patients met the inclusion criteria [mean age of 41.2 (± 15.5) years, 871 (53%) female]. Sixty percent (n = 993) of the procedures were performed laparoscopically and 128 (12.8%) cases were converted to open. Ninety-five patients (5%) underwent emergent resections. Thirty percent (n = 507) of patients had at least one postoperative complication within 30 days of surgery. Ileus (16%), transfusion (7%), and organ-space surgical site infection (6%) were the most common morbidities. Independent risk factors for postoperative morbidity were male gender (p = 0.01), open surgery (p = 0.002), preoperative severe anemia (p = 0.001), and preoperative weight loss (p = 0.04). CONCLUSION: Approximately one third of the patients who undergo colon resection for Crohn's disease experience postoperative complications. Preoperative optimization of nutrition and anemia may improve outcomes. Laparoscopic technique appears to be the preferred surgical treatment option for resection when feasible.

8 Article When Not to Pouch: Important Considerations for Patient Selection for Ileal Pouch-Anal Anastomosis. 2017

Chang, Shannon / Shen, Bo / Remzi, Feza. ·Dr Chang is an assistant professor of medicine at the Inflammatory Bowel Disease Center at New York University Langone Medical Center in New York, New York. Dr Shen is a professor of medicine at the Center for Inflammatory Bowel Diseases at the Digestive Disease and Surgery Institute at The Cleveland Clinic Foundation in Cleveland, Ohio. Dr Remzi is a professor of surgery and director of the Inflammatory Bowel Disease Center at New York University Langone Medical Center. ·Gastroenterol Hepatol (N Y) · Pubmed #28867978.

ABSTRACT: Ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment for patients who undergo colectomy and wish to avoid a permanent ileostomy. The overall outcomes are positive, with an improved quality of life and stable long-term pouch retention. However, certain conditions or disease states may be at a higher risk of pouch dysfunction or failure. For example, obese patients have an increased risk for postoperative complications. In addition, women with a history of obstetric complications and elderly patients with a history of sphincter damage or dysfunction may be at an increased risk for postoperative incontinence, although quality-of-life indices do not necessarily correlate with incontinence scores. Advanced age itself is not a contraindication to pouch surgery, and elderly patients can be considered for IPAA based on individual functionality and comorbidities. Pelvic radiation may lead to pouch dysfunction. Finally, patients with Crohn's disease and indeterminate colitis may have increased complications with IPAA, but highly specific patient selection leads to good rates of pouch retention. This article examines several clinical scenarios that require careful thought prior to considering IPAA.

9 Article Long-term Outcomes After Continent Ileostomy Creation in Patients With Crohn's Disease. 2017

Aytac, Erman / Dietz, David W / Ashburn, Jean / Remzi, Feza H. ·Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio. ·Dis Colon Rectum · Pubmed #28383450.

ABSTRACT: 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 http://links.lww.com/DCR/A327.

10 Article Long-Term Outcomes in Indeterminate Colitis Patients Undergoing Ileal Pouch-Anal Anastomosis: Function, Quality of Life, and Complications. 2017

Jackson, Katharine L / Stocchi, Luca / Duraes, Leonardo / Rencuzogullari, Ahmet / Bennett, Ana E / Remzi, Feza H. ·Department of Colorectal Surgery, 9500, Euclid Avenue, A30, Cleveland, OH, 44195, USA. kljackson14@hotmail.com. · Department of Colorectal Surgery, 9500, Euclid Avenue, A30, Cleveland, OH, 44195, USA. · Department of Pathology, 9500, Euclid Avenue, L25, Cleveland, OH, 44195, USA. ·J Gastrointest Surg · Pubmed #27832426.

ABSTRACT: INTRODUCTION: It is uncertain whether the outcomes of patients with indeterminate colitis (IC) undergoing ileal pouch-anal anastomosis (IPAA) deteriorate over time. The aim of this study was to determine the long-term pouch function, quality of life, complications, and incidence of Crohn's disease after IPAA for patients with IC compared to ulcerative colitis (UC). METHODS: A case matched analysis was performed on patients undergoing IPAA for pathologically confirmed IC or UC, between 1985 and 2014. Patients were case matched for age ± 5 years, gender, date of surgery ± 3 years, type of anastomosis and presence of a diverting loop ileostomy. All patients were followed up for greater than six months. RESULTS: 448 patients were case matched, the average age was 36.8 year old and 52.7 % of patients were male. Mean follow-up was 122.06 months (+/- 80.77 months). There were statistically and clinically comparable number of daytime bowel movements (5.7 v 5.5, p = 0.45), rates of incontinence (26.1 % v 18.3 %, p = 0.09) and nighttime seepage in patients (23.1 % v 28.4 %, p = 0.28) with IC and UC. Quality of life markers and patient restrictions were comparable between the two groups. Rates of pelvic sepsis (IC 8.5 %, UC 8.5 %, p = 0.99) and anastomotic leak (IC 3.1 %, UC 4.0 %, p = 0.61) were similar but fistula formation (IC 15.6 %, UC 8.0 %, p = 0.01) and IPAA Crohn's disease rates (IC 6.7 %, UC 2.7 %, p = 0.04) were significantly increased in IC patients. There was no statistically significant difference in pouch failure rates for IC and UC (5.8 % vs.4.9 %, p = 0.58). CONCLUSION: Patients undergoing IPAA for IC have a higher risk of post-operative fistulae and development of Crohn's disease, but comparable morbidity, functional outcomes, quality of life scores and pouch failure rates when compared to UC patients. Long-term data confirms that IPAA is a good surgical option in patients with IC.

11 Article Comparison of Endoscopic Dilation vs Surgery for Anastomotic Stricture in Patients With Crohn's Disease Following Ileocolonic Resection. 2017

Lian, Lei / Stocchi, Luca / Remzi, Feza H / Shen, Bo. ·Center for Inflammatory Bowel Diseases, Cleveland Clinic, Cleveland, Ohio; Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio; Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. · Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio. · Center for Inflammatory Bowel Diseases, Cleveland Clinic, Cleveland, Ohio. Electronic address: shenb@ccf.org. ·Clin Gastroenterol Hepatol · Pubmed #27816758.

ABSTRACT: BACKGROUND & AIMS: It is not clear whether endoscopic balloon dilation (EBD) or surgery is a more effective treatment for ileocolonic anastomosis (ICA) stricture in patients with Crohn's disease. We aimed to compare long-term outcomes of patients who underwent EBD versus surgery for ICA stricture. METHODS: We performed a retrospective study of adult patients with ICA stricture treated with EBD (n = 176) or surgery (n = 131), from December 1998 through May 2013, at the Cleveland Clinic Foundation. Demographic, clinical, endoscopic, histologic, and radiographic data were collected. Disease duration was defined as the time interval from the diagnosis of Crohn's disease to the treatment for ICA stricture. Data were collected for a median follow-up period of 2.9 years (interquartile range, 0.9-5.7 years). Multivariable analyses were performed to assess risk factors for subsequent surgery. RESULTS: Patients in the surgery group had a longer median interval from inception (first encounter with patients at either follow-up endoscopy or presentation with obstructive symptoms) until subsequent surgery (4.7 years; interquartile range, 2.2-8.8 vs 1.8 years; interquartile range, 0.4-4.1 years). The average time to surgery delayed by EBD was 6.45 years. Upfront surgery for ICA stricture (hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.32-0.76), a longer time for diagnosis to inception (HR, 0.96; 95% CI, 0.93-0.99), a shorter interval from the last surgery to inception (HR, 1.05; 95% CI, 1.01-1.09), only 1 previous resection (HR, 0.41; 95% CI, 0.26-0.66), and the absence of concurrent strictures (HR, 1.68; 95% CI, 0.97-2.9) were associated with a significantly lower risk for subsequent surgery. CONCLUSIONS: Surgical resection for ICA stricture in patients with Crohn's disease was associated with a lower risk of further surgery than EBD. However, EBD could delay time until need for a second surgery and be attempted first for patients with a lower risk for disease progression. Patients at risk for recurrent disease may benefit from upfront surgical therapy.

12 Article Characteristics of learning curve in minimally invasive ileal pouch-anal anastomosis in a single institution. 2017

Rencuzogullari, Ahmet / Stocchi, Luca / Costedio, Meagan / Gorgun, Emre / Kessler, Hermann / Remzi, Feza H. ·Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland Clinic Foundation, A-30, 9500 Euclid Ave, Cleveland, OH, 44195, USA. · Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland Clinic Foundation, A-30, 9500 Euclid Ave, Cleveland, OH, 44195, USA. stocchl@ccf.org. ·Surg Endosc · Pubmed #27412123.

ABSTRACT: BACKGROUND: Previous work from our institution has characterized the learning curve for open ileal pouch-anal anastomosis (IPAA). The purpose of the present study was to assess the learning curve of minimally invasive IPAA. METHODS: Perioperative outcomes of 372 minimally invasive IPAA by 20 surgeons (10 high-volume vs. 10 low-volume surgeons) during 2002-2013, included in a prospectively maintained database, were assessed. Predicted outcome models were constructed using perioperative variables selected by stepwise logistic regression, using Akaike's information criterion. Cumulative sums (CUSUM) of differences between observed and predicted outcomes were graphed over time to identify possible improvement patterns. RESULTS: Institutional pelvic sepsis and other pouch morbidity rates (hemorrhage, anastomotic separation, pouch failure, fistula) significantly decreased (18.2 vs. 7.0 %, CUSUM peak after 143 cases, p = 0.001; 18.4 vs. 5.3 %, CUSUM peak after 239 cases, respectively, p < 0.001). Institutional total proctocolectomy mean operative times significantly decreased (307 min vs. 253 min, CUSUM peak after 84 cases, p < 0.001), unlike completion proctectomy (p = 0.093) or conversion rates (10 vs. 5.4 %, p = 0.235). Similar learning curves were identified among high-volume surgeons but not among low-volume surgeons. Learning curves were identified in the two busiest individual surgeons for pelvic sepsis (peaks at 47 and 9 cases, p = 0.045 and p = 0.002) and in one surgeon for operative times (CUSUM peak after 16 and 13 cases for both total proctocolectomy and completion proctectomy (p < 0.001 and p = 0.006) but not for other pouch complications (peak at 49 and 41 cases, p = 0.199 and p = 0.094). CONCLUSION: Pouch complications, particularly pelvic sepsis, are the most consistent and relevant learning curve end points in laparoscopic IPAA.

13 Article Long-term Outcomes of Sphincter-Saving Procedures for Diffuse Crohn's Disease of the Large Bowel. 2016

Li, Yi / Stocchi, Luca / Mu, Xing / Cherla, Deepa / Remzi, Feza H. ·Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio. ·Dis Colon Rectum · Pubmed #27824704.

ABSTRACT: BACKGROUND: Total abdominal colectomy with ileorectal anastomosis for Crohn's colitis is acceptable in the presence of a suitable rectum. Intentional IPAA has been proposed for diffuse Crohn's proctocolitis without enteric or anoperineal disease. OBJECTIVE: The aim of this study was to evaluate the long-term outcomes of sphincter-saving procedures for large-bowel Crohn's disease. DESIGN: Patients with preoperative Crohn's disease diagnosis undergoing intentional IPAA and ileorectal anastomosis were included. SETTINGS: The study was conducted at a tertiary care research center. PATIENTS: Ileorectal anastomosis was performed in 75 patients with Crohn's disease, whereas 32 patients underwent intentional IPAA. MAIN OUTCOME MEASURES: Long-term functional results and permanent stoma requirement of sphincter-saving operations were assessed. Quality of life and postoperative medication use were also compared with a control group of patients undergoing total proctocolectomy and end ileostomy. RESULTS: Patients undergoing ileorectal anastomosis were older and had longer disease duration, higher prevalence of perianal and penetrating disease, and history of small-bowel resection than those receiving IPAA. Indications for surgery, preoperative use of immunomodulators, and postoperative use of biologics were also significantly different. Although functional defecatory outcomes were comparable, reported quality of life 3 years after surgery was significantly better in patients who underwent IPAA than in patients with ileorectal anastomosis. Patients with IPAA were associated with significantly lower cumulative rates of surgical recurrence (HR = 0.28 (95% CI, 0.09-0.84); p = 0.017), indefinite stoma diversion (HR = 0.35 (95% CI, 0.13-0.99); p = 0.039), and proctectomy with end ileostomy (HR = 0.27 (95% CI, 0.07-0.96); p = 0.030) than those with ileorectal anastomosis. LIMITATIONS: The study was limited by its retrospective nature and small sample size. CONCLUSIONS: Contemporary patients selected to have intentional IPAA for Crohn's colitis have disease characteristics very different from those selected to have ileorectal anastomosis. Long-term follow-up confirms intentional IPAA as an acceptable option in selected patients with Crohn's colitis.

14 Article Comparable outcomes of the consistent use versus switched use of anti- tumor necrosis factor agents in postoperative recurrent Crohn's disease following ileocolonic resection. 2016

Li, Yi / Stocchi, Luca / Rui, Yuanyi / Remzi, Feza H / Shen, Bo. ·Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, OH, 44195, USA. · Department of Gastroenterology/Hepatology, Desk A31, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. shenb@ccf.org. ·Int J Colorectal Dis · Pubmed #27475090.

ABSTRACT: PURPOSE: There are no published data or guidelines on whether the same anti-tumor-necrosis factor (TNF) agents used preoperatively or different anti-TNF agents are preferable to treat postoperative recurrence. Our aim was to compare the efficacy of the consistent vs. switched anti-TNF approaches in patients with recurrent Crohn's disease (CD) after their inception ileocolonic resection (ICR). METHODS: Patients with CD receiving anti-TNF agents before the inception ICR who were treated for clinical recurrence with the same or different anti-TNF agents after surgical resection were included in the study. The outcome of the study was the need for the subsequent resection of ileocolonic anastomosis (ICA) as calculated with survival curves. RESULTS: Eighty-five patients were included in the study. The mean age of the whole cohort at the inception ICR was 35.1 ± 13.5 years. The whole cohort consisted 42 (49.4 %) in the consistent group and 43 (50.6 %) in the switched group. No significant differences were observed in demographic and clinical variables between the two groups. During the median follow-up of 1.5 (interquartile range, 0.8-3.1) years, seven (16.7 %) patients in the consistent group and eight (18.6 %) in the switched group required the repeat resection of ICA. Similar results were found in terms of the subsequent resection of ICA-free survival (hazard ratio = 1.36, 95 % confidence interval 0.49-3.76, P = 0.54) between the consistent and switched groups. CONCLUSIONS: The adherence to the same anti-TNF agent appeared to be as effective as the switching approach to different anti-TNF agent in treating postoperative recurrent CD after the inception ICR.

15 Article Case-matched Comparison of Robotic Versus Laparoscopic Proctectomy for Inflammatory Bowel Disease. 2016

Rencuzogullari, Ahmet / Gorgun, Emre / Costedio, Meagan / Aytac, Erman / Kessler, Hermann / Abbas, Maher A / Remzi, Feza H. ·Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH. ·Surg Laparosc Endosc Percutan Tech · Pubmed #27258914.

ABSTRACT: The present study reports an early institutional experience with robotic proctectomy (RP) and outcome comparison with laparoscopic proctectomy (LP) in patients with inflammatory bowel disease (IBD). Patients who underwent either RP or LP during proctocolectomy for IBD between January 2010 and June 2014 were matched (1:1) and reviewed. Twenty-one patients undergoing RP fulfilled the study criteria and were matched with an equal number of patients who had LP. Operative time was longer (304 vs. 213 min, P=0.008) and estimated blood loss was higher in the RP group (360 vs. 188 mL, P=0.002). Conversion rates (9.5% vs. 14.3%, P>0.99), time to first bowel movement(2.29±1.53 vs. 2.79±2.26, P=0.620), and hospital length stay(7.85±6.41 vs. 9.19±7.47 d, P=0.390) were similar in both groups. No difference was noted in postoperative complications, ileal pouch to anal canal anastomosis-related outcomes, Cleveland Global Quality of Life, and Short Form-12 health survey outcomes between RP and LP. Our good results with standard laparoscopy are unlikely to be improved with robotics in proctectomy cases. Potential benefits of robotic approach for completion proctectomy warrant further investigation as experience grows with robotics.

16 Article Association of Preoperative Narcotic Use With Postoperative Complications and Prolonged Length of Hospital Stay in Patients With Crohn Disease. 2016

Li, Yi / Stocchi, Luca / Cherla, Deepa / Liu, Xiaobo / Remzi, Feza H. ·Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio. · Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio. ·JAMA Surg · Pubmed #26913479.

ABSTRACT: IMPORTANCE: The use of narcotics among patients with Crohn disease (CD) is endemic. OBJECTIVE: To evaluate the association between preoperative use of narcotics and postoperative outcomes in patients with CD. DESIGN, SETTING, AND PARTICIPANTS: Patients undergoing abdominal surgery for CD at a tertiary referral center between January 1998 and June 2014 were identified from an institutional prospectively maintained CD database. MAIN OUTCOMES AND MEASURES: Primary end points were overall morbidity, postoperative hospital length of stay, and readmission. Univariate and multivariate analyses were used to assess possible associations between postoperative outcomes and demographic and clinical variables, including preoperative narcotic use. RESULTS: Of the 1331 patients included, the mean age for patients who had at least 1 pharmacy claim for narcotics within 1 month before surgery was 41.5 years and 41.1 years for patients without a pharmacy claim. Of 1461 abdominal operations for CD, 267 (18.3%) were performed on patients receiving preoperative narcotics. Patients receiving narcotics were more likely to have a current smoking habit (P < .001) with perianal disease (P = .046) and undergoing treatment with biologics (P = .04). Patients with preoperative narcotic use had a longer mean (SD) length of stay (11.2 [8.9] vs 7.7 [5.5]; P < .001) and were more likely to develop postoperative complications (52.8% vs 40.8%; P < .001). Multivariable analysis indicated that preoperative narcotic use was the only independent risk factor associated with both postoperative morbidity (odds ratio = 1.36; 95% CI = 1.02-1.82; P = .04) and prolonged hospital stay (estimate = 2.91; SE = 0.44; P < .001). Subgroup analysis indicated that outpatient narcotic users had increased incidence of adverse postoperative outcomes compared with inpatient-only narcotic users. CONCLUSIONS AND RELEVANCE: Preoperative use of narcotics in patients undergoing abdominal surgery for CD is associated with worse postoperative outcomes. Before starting regular narcotic use, patients with CD should be considered for surgical intervention.

17 Article Association between high visceral fat area and postoperative complications in patients with Crohn's disease following primary surgery. 2016

Ding, Z / Wu, X-R / Remer, E M / Lian, L / Stocchi, L / Li, Y / McCullough, A / Remzi, F H / Shen, B. ·Departments of Colorectal Surgery, Abdominal Imaging, and Gastroenterology/Hepatology, Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio, USA. ·Colorectal Dis · Pubmed #26391914.

ABSTRACT: AIM: The aim of this study was to determine the association between visceral fat area (VFA) on CT and postoperative complications after primary surgery in patients with Crohn's disease (CD). METHOD: Inclusion criteria were patients with a confirmed diagnosis of CD who had preoperative abdominal CT scan. The areas of total fat, subcutaneous fat and visceral fat were measured using an established image-analysis method at the lumbar 3 (L3) level on CT cross-sectional images. Visceral obesity was defined as a visceral fat area (VFA) of ≥ 130 cm(2) . Clinical variables, intra-operative outcomes and postoperative courses within 30 days were analysed. RESULTS: A total of 164 patients met the inclusion criteria. Sixty-three (38.4%) patients had postoperative complications. The mean age of the patients with complications (the study group) was 40.4 ± 15.4 years and of those without complications (the control group) was 35.8 ± 12.9 years (P = 0.049). There were no differences in disease location and behaviour between patients with or without complications (P > 0.05). In multivariable analysis, VFA [odds ratio (OR) = 2.69; 95% confidence interval (CI): 1.09-6.62; P = 0.032] and corticosteroid use (OR = 2.86; 95% CI: 1.32-6.21; P = 0.008) were found to be associated with postoperative complications. Patients with visceral obesity had a significantly longer operative time (P = 0.012), more blood loss (P = 0.019), longer bowel resection length (P = 0.003), postoperative ileus (P = 0.039) and a greater number of complications overall (P < 0.001). CONCLUSION: High VFA was found to be associated with an increased risk for 30-day postoperative complications in patients with CD undergoing primary surgery.

18 Article Salvage surgery after failure of endoscopic balloon dilatation versus surgery first for ileocolonic anastomotic stricture due to recurrent Crohn's disease. 2015

Li, Y / Stocchi, L / Shen, B / Liu, X / Remzi, F H. ·Departments of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA. · Departments of Gastroenterology/Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USA. · Departments of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA. ·Br J Surg · Pubmed #26313750.

ABSTRACT: BACKGROUND: Both surgical resection and endoscopic balloon dilatation are treatment options for ileocolonic anastomotic stricture caused by recurrent Crohn's disease unresponsive to medications. Perioperative outcomes of salvage surgery owing to failed endoscopic balloon dilatation in comparison with performing surgery first for the same indication are unclear. METHODS: An analysis of a prospectively maintained Crohn's disease database was carried out to compare perioperative outcomes of patients who had surgery for failure of endoscopic balloon dilatation with outcomes in patients who underwent resection first for ileocolonic anastomotic stricture caused by recurrent Crohn's disease between 1997 and 2013. RESULTS: Of 194 patients, 114 (58·8 per cent) underwent surgery without previous endoscopic balloon dilatation. The remaining 80 patients had salvage surgery after one or more endoscopic balloon dilatations during a median treatment span of 14·5 months. Patients in the salvage surgery group had a significantly shorter length of anastomotic stricture (P < 0·001). Salvage surgery was associated with increased rates of stoma formation (P = 0·030), overall surgical-site infection (SSI) (P = 0·025) and organ/space SSI (P = 0·030). In multivariable analysis, preoperative endoscopic balloon dilatation was independently associated with both postoperative SSI (odds ratio 3·16, 95 per cent c.i. 1·01 to 9·84; P = 0·048) and stoma diversion (odds ratio 3·33, 1·14 to 9·78; P = 0·028). CONCLUSION: Salvage surgery after failure of endoscopic balloon dilatation is associated with increased adverse outcomes in comparison with surgery first. This should be discussed with patients being considered for endoscopic balloon dilatation for ileocolonic anastomotic stricture due to recurrent Crohn's disease.

19 Article Perioperative Blood Transfusion and Postoperative Outcome in Patients with Crohn's Disease Undergoing Primary Ileocolonic Resection in the "Biological Era". 2015

Li, Yi / Stocchi, Luca / Rui, Yuanyi / Liu, Ganglei / Gorgun, Emre / Remzi, Feza H / Shen, Bo. ·Department of Colorectal Surgery, the Cleveland Clinic Foundation, Cleveland, OH, USA. · Department of Gastroenterology/Hepatology, the Cleveland Clinic Foundation, Cleveland, OH, USA. shenb@ccf.org. · Center for Inflammatory Bowel Disease, Digestive Disease Institute, Desk A31, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. shenb@ccf.org. ·J Gastrointest Surg · Pubmed #26286365.

ABSTRACT: BACKGROUND: Perioperative blood transfusion has been shown to be associated with inflammatory response and immunosuppression. Patients receiving blood transfusion may have an increased risk for developing postoperative morbidities. The impact of blood transfusion on the postoperative recurrence of Crohn's disease (CD) has been controversial. The aim of this study was to assess the effect of blood transfusion on postoperative outcomes in CD in the current biological era. METHODS: This historical cohort study involved data collection and analysis of CD patients who underwent the index ileocolonic resection in our institution between 2000 and 2012. Postoperative complications were compared between the transfused and nontransfused patients. The effects of perioperative blood transfusion on postoperative complications and disease recurrence were analyzed with both univariate and multivariate analyses. RESULTS: A total of 318 patients were included in the study, and 52 of them (16.5 %) received perioperative blood transfusion. Blood transfusion was found to be associated with an increased risk of postoperative infectious and noninfectious complications both in univariate (P < 0.001 for each) and multivariable analyses (infectious complications: odds ratio [OR] = 8.73, 95 % confidence interval [CI] 2.85-26.78, P < 0.001; noninfectious complications: OR = 3.64, 95 % CI 1.30-10.18; P = 0.014). In addition, the Cox regression model indicated that blood transfusion was associated with both surgical (hazard ratio [HR] = 3.43, 95 % CI 1.92-6.13; P < 0.001) and endoscopic (HR = 2.08, 95 % CI 1.38-3.14; P < 0.001) CD recurrence following the index surgery. CONCLUSION: Adverse outcomes after perioperative blood transfusion for the primary ileocolonic resection for CD resemble findings in surgery for other diseases. The presumed immunosuppressive effect of blood transfusion did not confer any protective effect on disease recurrence.

20 Article Presence of Granulomas in Mesenteric Lymph Nodes Is Associated with Postoperative Recurrence in Crohn's Disease. 2015

Li, Yi / Stocchi, Luca / Liu, Xiuli / Rui, Yuanyi / Liu, Ganglei / Remzi, Feza H / Shen, Bo. ·*Department of Colorectal Surgery, †Department of Anatomic Pathology, and ‡Center for Inflammatory Bowel Diseases, Cleveland Clinic Foundation, Cleveland, Ohio. ·Inflamm Bowel Dis · Pubmed #26218143.

ABSTRACT: BACKGROUND: The association between the presence of granulomas in the mesenteric lymph node (MLN) and postoperative recurrent Crohn's disease (CD) is unknown. Our aim was to assess the predictive value of the presence of granulomas in MLN as well as in bowel wall for postoperative recurrence of CD. METHODS: Patients with CD who underwent the index ileocolonic resection between 2004 and 2012 were included. Surgical pathology reports were reviewed for the presence and location of granulomas. The status of MLN granulomas was confirmed by re-review of surgical pathology specimen from randomly sampled patients by an expert pathologist. Both univariable and multivariable analyses were performed to assess the risk factors associated with postoperative recurrent CD. RESULTS: A total of 194 patients were included. Granulomas were detected in the MLN in 23 patients (11.9%), and in the intestinal wall in 57 (29.4%). On Kaplan-Meier curve, the presence of granulomas in MLN was found to be a risk factor for postoperative endoscopic recurrence (P = 0.015) as well as surgical recurrence (P = 0.035). In contrast, granulomas in the bowel wall, which was not found to be associated with neither endoscopic recurrence (P = 0.94) or surgical recurrence (P = 0.56). On Cox proportional hazards regression analysis, the presence of MLN granulomas was independently associated with an increased risk for both postoperative endoscopic recurrence (hazard ratio [HR] = 1.91; 95% confidence interval [CI], 1.06-3.45; P = 0.031) and surgical recurrence (HR = 3.43; 95% CI, 1.18-9.99; P = 0.023). CONCLUSIONS: The presence of granulomas in MLN but not in intestine per se was found to be an independent risk factor for recurrence in CD patients undergoing ileocolonic resection.

21 Article Preoperative risk factors and radiographic findings predictive of laparoscopic conversion to open procedures in Crohn's disease. 2015

Mino, Jeffrey S / Gandhi, Namita S / Stocchi, Luca L / Baker, Mark E / Liu, Xiaobo / Remzi, Feza H / Monteiro, Rosebel / Vogel, Jon D. ·Department of General Surgery, Cleveland Clinic Foundation, A100 Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA, minoj@ccf.org. ·J Gastrointest Surg · Pubmed #25820486.

ABSTRACT: INTRODUCTION: Laparoscopy is accepted as a standard surgical approach for Crohn's disease. However, the rate of conversion is high, ranging from 15 to 70 % depending on the population. There are also concerns that conversion results in worsened outcomes versus an initial open procedure. METHODS: This study evaluated preoperative radiographic findings to determine who is at increased risk of conversion and may therefore benefit from an initial open approach. A case-matched study included patients from 2004 to 2013 with preoperative CTE/MRE who underwent laparoscopic surgery converted to an open approach, and compared them to laparoscopically completed controls with similar age, same surgeon, and number of previous abdominal operations. Studies were reviewed by two blinded radiologists. Variables included abdominal AP diameter, amount of subcutaneous fat, peritoneal versus pelvic location of disease (greater or lesser hemipelvis or abdomen), intestinal location of disease (colon, TI, ileum, jejunum), and presence, length, and location of strictures, simple or complex fistula, phlegmon, or abscess. Conditional logistic regression evaluated relationships between radiographic variables and conversion. Twenty-seven patients meeting study criteria were compared with 81 controls. RESULTS: A negative association between conversion and disease in the left lesser pelvis was found (p = 0.019) and neared significance for left abdomen (p = 0.08). Positive correlations were found with pelvic fistulas (p = 0.003), complex fistulas (p = 0.017), and pelvic abscesses (p = 0.009) and neared significance for Society of Abdominal Radiology classification (p = 0.058). CONCLUSION: Preoperative imaging in patients with Crohn's disease can help in selecting the most suitable cases to approach laparoscopically and reduce conversion rates and should be evaluated in conjunction with other preoperative factors.

22 Article Prediction of need for surgery after endoscopic balloon dilation of ileocolic anastomotic stricture in patients with Crohn's disease. 2015

Lian, Lei / Stocchi, Luca / Shen, Bo / Liu, Xiaobo / Ma, Jessica / Zhang, Brook / Remzi, Feza. ·1 Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio 2 Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio 3 Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio. ·Dis Colon Rectum · Pubmed #25751799.

ABSTRACT: BACKGROUND: Endoscopic balloon dilation is used to treat ileocolic anastomotic stricture attributed to recurrent Crohn's disease. OBJECTIVE: The purpose of this work was to investigate long-term outcomes after dilation of ileocolic anastomotic stricture and to identify risk factors associated with the need for subsequent surgical intervention. DESIGN: This was a retrospective study based on chart review of an electronic medical chart system. SETTINGS: The study was conducted at a tertiary care center. PATIENTS: All of the eligible patients with ileocolic anastomotic stricture attributed to recurrent Crohn's disease treated with endoscopic dilation between December 1998 and May 2013 were evaluated. Patients with concurrent enterocutaneous fistula or abdominal or pelvic abscess were excluded. MAIN OUTCOME MEASURES: The main outcome measure was the need for subsequent salvage surgery because of stricture-related symptoms. RESULTS: A total of 185 patients with Crohn's disease (45.9% women; mean age, 43.1 years; symptomatic strictures in 80%) underwent 462 endoscopic dilations of ileocolic anastomosis (median per-patient dilations, 2; range, 1-3). During a mean follow-up of 3.9 years, 27 patients (14.6%) required hospitalization without surgery for stricture-related symptoms, and 66 patients (35.7%) required subsequent salvage surgery. Specific medical management, type of anastomosis, and endoscopic intralesional steroid injection had no impact on the risk of needing surgery. Significant factors associated with the need for surgery on multivariable analysis were symptomatic disease (HR, 3.54 [95% CI, 1.41-8.93]), longer time interval from last surgery (HR, 1.05 [95% CI, 1.01-1.10]), and radiographic proximal bowel dilation (HR, 2.36 [95% CI, 1.38-4.03]). A nomogram estimating the need for surgery was created with a concordance index of 0.67. LIMITATIONS: The study was limited by its retrospective design. CONCLUSIONS: Although endoscopic dilation is a valid option for ileocolic anastomotic stricture attributed to recurrent Crohn's disease, the need for surgery is common. The nomogram can identify patients who might benefit from upfront surgery.

23 Article Risk factors for Crohn’s disease of the neo-small intestine in ulcerative colitis patients with total proctocolectomy and primary or secondary ileostomies. 2015

Du, Peng / Sun, Chao / Ashburn, Jean / Wu, Xianrui / Philpott, Jessica / Remzi, Feza H / Shen, Bo. · ·J Crohns Colitis · Pubmed #25518056.

ABSTRACT: BACKGROUND: De novo Crohn’s disease (CD) of the neo-small intestine in ulcerative colitis (UC) patients after total proctocolectomy (TPC) is a new disease entity, which may persist even after a secondary diverting permanent ileostomy for pouch failure. We sought to compare outcomes of primary ileostomy (PI, i.e., stoma created after colectomy without trying of ileal pouch) and secondary ileostomy (SI, i.e., stoma created after pouch failure) and to evaluate factors associated with the development of CD of the neo-small intestine proximal to ileostomy. METHODS: A total of 123 eligible patients were identified from our Pouch Center Registry (PI group, n = 57 and SI group, n = 66). Demographics, clinical features and outcomes (CD of theneo-small intestine, non-CD related strictures, requirement of CD-related medications use, ileostomy-associated hospitalization, ileostomy failure with stoma revision/relocation, and shortgut syndrome) were compared. Step-wise logistic regression models were performed. RESULTS: The median follow-up for the whole cohort was 5.0 (2.0–12.0) years. Younger age at diagnosis and surgery, family history of IBD, toxic megacolon/fulminant colitis, pre-diversion severe diarrhea, prediversion anti-TNF biological therapy, arthralgia/arthropathy and staged surgery were more common in the SI group (p < 0.05). In multivariate analysis, the presence of SI [odds ratio (OR), 8.23; 95% confidence interval (CI), 2.43–27.85], family history of IBD (OR, 9.14; 95% CI, 3.13–26.69), and pre-diversion of weight loss (OR, 3.72; 95% CI, 1.23–11.21) were contributing factors for developing CD of the neo-small intestine. CONCLUSIONS: CD of the neo-small intestine in stoma patients was associated with the presence of SI, family history of IBD, and pre-diversion poor nutrition status. Patients with secondary ileostomy due to pouch failure should be carefully monitored. Aggressive medical, endoscopic or surgical therapy may be needed in patients at risk, before permanent diversion.

24 Article Factors affecting the fate of faecal diversion in patients with perianal Crohn's disease. 2015

Gu, J / Valente, M A / Remzi, F H / Stocchi, L. ·Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA. ·Colorectal Dis · Pubmed #25306934.

ABSTRACT: AIM: A study was carried out with the aim of identifying potential factors which might influence the fate of patients undergoing faecal diversion by stoma in perianal Crohn's disease. METHOD: Patients with severe perianal Crohn's disease undergoing faecal diversion between 1994 and 2012 were identified and the factors associated with stoma closure were assessed using univariate and multivariate analysis. RESULTS: Of 138 diverted patients, 30 (22%) achieved stoma closure, 45 (33%) had a stoma with the rectum left in situ and 63 (45%) underwent proctectomy with permanent stoma formation after a mean follow-up of 5.7 years. Univariate analysis demonstrated that synchronous colonic (P = 0.004) or rectal (P = 0.021) disease involvement and an increased frequency of loose seton placement (P = 0.001) adversely affected successful stoma closure rates. Multivariate analysis indicated a significant association between the inability to achieve stoma closure and persisting rectal involvement (OR 7.5, 95% CI 2.4-33.4), one or two placements of a loose seton (OR 3.3, 95% CI 1.4-8.8) and more than two placements (OR 6.9, 95% CI 1.2-132.5). No specific medical management was associated with an improved stoma closure rate, including biological agents when these were available (P = 0.25). CONCLUSION: The fate of temporary faecal diversion in patients with perianal Crohn's disease is adversely affected by aggressive disease characteristics. No particular treatment, including biological therapy, was associated with an improved outcome.

25 Article The J-pouch for patients with Crohn's disease and indeterminate colitis: (when) is it an option? 2014

Turina, Matthias / Remzi, Feza H. ·Department of Colorectal Surgery; Digestive Disease Institute, Cleveland Clinic Main Campus, Mail Code A-30, 9500 Euclid Ave, Cleveland, OH, 44195, USA. ·J Gastrointest Surg · Pubmed #24777433.

ABSTRACT: -- No abstract --

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