Reoperations at the ileostomy in Crohn's disease reflect inflammatory activity rather than surgical stoma complications alone

After ileostomy construction for Crohn's disease reoperations due to ileal recurrences are thought to be unusually rare, whereas reconstructions of th e ileostomy due to stoma complications are considered to be unusually frequ ent. It remains unclear why the natural course of a disease as well as outs tanding results of a standardized surgical procedure should be perverted. T herefore reconstructions of the ileostomy in 92 patients colectomized durin g a 12.5-year period and followed up for 5.4 years were analyzed concerning preoperative indication and postoperative histology. In 28 patients (30.4% ) a total of 42 reoperations were necessary. The clinical indication was pr estomal recurrence in 5 reoperations (11.9%) and stoma complications in 37 (88.1%). In contrast, ileal recurrence was demonstrated histologically in 2 8 specimens (66.7%) and healthy ileum in the rest. There was a statisticall y significant association between fibrotic recurrence and stoma stenosis/re traction and a trend for association between penetrating recurrence and per istomal ulceration. The cumulative risk for a first reoperation due to clin ical recurrence was calculated at 3.3% and 14.0% at 5 and 10 years postoper atively, whereas the corresponding figures for stoma complications were 25. 7% and 40.0%. In contrast, the cumulative risk that a recurrence was found histologically on the occasion of the reoperation was 23.0% and 35.0%, whil e the probability that the ileum was healthy in the case of a stoma complic ation remained low. In conclusion, most reoperations after ileostomy-constr uction in Crohn's disease are associated histologically with recurrent infl ammation. The accentuation of the inflammatory recrudescence at the stoma i tself or the prestomal ileum is decisive for the clinical presentation as s toma complication or intestinal complication. These findings reinforce both well known characteristics of the inflammatory disease and of established surgery.