eP554 - Outcomes of Fecal Diversion for Perianal Crohn's Disease: A Retrospective Case Series

Purpose/Background: Patients with perianal Crohn's Disease (CD) often face significant health challenges and may require multiple surgeries and chronic seton placement. Despite advances in medical therapies, some individuals have complex anal fistula that are not well controlled despite abscess drainage and seton placement. When local surgical treatments prove ineffective, the next surgical step is temporary fecal diversion with loop ileostomy or colostomy. In this study, we set out to understand the long-term outcomes of patients who undergo fecal diversion for perianal CD.Methods/Interventions: This retrospective case series analyzed the medical records of patients over the age of 18 diagnosed with perianal CD who underwent fecal diversion surgery for anal fistula from 2013-2023. All patients were followed up at our institutions’ multidisciplinary Inflammatory Bowel Disease (IBD) center with medical optimization by IBD gastroenterologists. Relevant clinical data, including patient demographics, disease characteristics, treatments, and surgical details, were collected. The primary outcome was rate of stoma closure, with secondary outcomes including removal of seton after diversion, stoma complication, anal fistula recurrence after stoma closure, and progression to proctectomy for perianal CD.Results/Outcomes: We identified 11 patients with CD who underwent fecal diversion surgery for complex anal fistula. 54% were female, and median duration of CD before diversion surgery was 8 years. All patients had multiple setons prior to surgery and were on biologic therapy at the time of ostomy creation. Loop ileostomy was most common (81%), while there was 1 loop colostomy and 1 end ileostomy. Median of follow up was 3 years. A patient died of unrelated cause at 3 months with setons removed. At 6 months following diversion of 10 remaining patients, 4 patients (40%) required additional seton placement, 1 patient (10%) was able to have setons removed, and 5 patients (50%) were stable with setons in place. No patient had the stoma reversed due to improvement of perianal disease. One patient had ostomy reversal due to stoma complications, then had recurrent anal fistula with subsequent seton placements. Two other patients were complicated with parastomal hernias, while a separate patient required follow-up surgery for parastomal abscesses after a year from their diversion surgery. Two patients had perianal disease progression despite diversion and underwent proctectomy with end colostomy.Conclusion/

Discussion: Patients with perianal CD with complex fistula requiring fecal diversion surgery face considerable challenges, often necessitating permanent stomas. Surprisingly in our study, no patient achieved stoma reversal due to medical optimization of CD, but one patient (10%) had reversal due to stoma complications and now has recurrent setons in place. Two patients had disease progression requiring proctectomy with end colostomy. These findings emphasize the complex and chronic nature of perianal CD and highlight that once the perianal Crohn’s is severe enough for fecal diversion, there is a low success rate to achieve intestinal continuity in the future.