title: The role of a defunctioning stoma for colonic and perianal Crohn's disease in the biological era.
abstract: OBJECTIVE
  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.
  
  
  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% and 0%, respectively), while colitis was associated with a higher chance of restoring continuity (48%). Endoscopic or histological improvement in colitis after defunctioning was associated with a higher rate of restoring continuity (10/16, 63%) compared to no such improvement (4/15, 27%, p = 0.05). Those failing biologics had similar chance of restoration as those not receiving biologics, 15/57 (26%) and 5/19 (26%), respectively.
  
  
  CONCLUSIONS
  Overall response to colonic defunctioning was 41%. Successful restoration of continuity occurred in 27%, but 48% in the absence of perianal disease. Response is appreciably less in the pre-biologic era, so patient and physician expectations need to be managed appropriately.
authors.affiliation: a Unit of Colorectal Surgery, Department of General Surgery , Hospital Universitari Vall Hebrón , Barcelona , Spain.|b Unit of Colorectal Surgery, Department of Surgery , Oxford University Hospitals , Oxford , UK.
authors.forename: M
authors.initials: M
authors.lastname: Martí-Gallostra
authors.affiliation: b Unit of Colorectal Surgery, Department of Surgery , Oxford University Hospitals , Oxford , UK.|c Division of Surgery, Department of Clinical and Experimental Medicine, Faculty of Health Sciences , Linköping University , Linköping , Sweden.|d Department of Surgery , County Council of Östergötland , Linköping , Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Myrelid
authors.affiliation: b Unit of Colorectal Surgery, Department of Surgery , Oxford University Hospitals , Oxford , UK.
authors.forename: N
authors.initials: N
authors.lastname: Mortensen
authors.affiliation: e Translational Gastroenterology Unit , Oxford University Hospitals , Oxford , UK.
authors.forename: S
authors.initials: S
authors.lastname: Keshav
authors.affiliation: e Translational Gastroenterology Unit , Oxford University Hospitals , Oxford , UK.
authors.forename: S P L
authors.initials: SP
authors.lastname: Travis
authors.affiliation: b Unit of Colorectal Surgery, Department of Surgery , Oxford University Hospitals , Oxford , UK.
authors.forename: B
authors.initials: B
authors.lastname: George
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001004:Anus Diseases / Q000150:complications*; D001691:Biological Therapy / Q000379:methods; D002648:Child; D003092:Colitis / Q000150:complications*; D003106:Colon / Q000473:pathology; D003424:Crohn Disease / Q000150:complications* / Q000628:therapy*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012006:Rectovaginal Fistula / Q000209:etiology; D054047:Surgical Stomas / Q000009:adverse effects*; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult