EP376 - Resource implications of a temporary diversion policy of proximal bowel after complex IBD surgery – special need for targeted resources

Purpose/Background: A policy of temporary proximal bowel diversion following complex IBD surgery – especially re-do Pouch surgery – has been advocated by us and other groups as a critical step in mitigating the severity of post-operative complications. However, there are consequences of making and having an ileostomy that are often overlooked. This study attempts to document the outcomes of such a policy in a quaternary center specializing in re-operative surgery for IBD.

Methods/Interventions: We conducted a retrospective review of all patients undergoing (diverting ileostomy) DI at our center between January-December 2024. Demographics, surgical approach, indications, and outcomes were analyzed. We reported short- and long-term outcomes and median time to closure after DI.

Results/Outcomes: A total of 112 patients underwent 151 DIs, with staged IPAA patients contributing two stomas each. Indications included 3 stage redo IPAA 53% (n=80), primary IPAA 6.6% (n=10), small bowel obstruction 9.3% (n=14), and other 31.1% (n=47), such as rectal cancer, diverticulitis, bowel perforation and ileocolic resection. The majority were loop ileostomies 93.4% (n=141); 6.6% (n=10) were end ileostomies. Open approach was used in 89 (58.9%) and minimally invasive in 62 (41.1%). The 30-day morbidity rate was 25.2%, with ileus (10.7%), dehydration (8.6%) and acute kidney injury (7.9%) being most frequent. Thirty-day readmission was 11.3%, most often for dehydration or high-output stoma, while reoperation occurred in 5.3%, primarily for ileostomy revision. Beyond 30 days, morbidity occurred in 24%, with stoma prolapse (9.3%), dehydration (7.3%) and stoma leakage (7.3%) being most common. Readmission beyond 30-day was 16.6%, most frequently due to stoma prolapse, dehydration and small bowel obstruction. Reoperation beyond 30 days occurred in 7.4%, again most often for stoma revision. At a median follow-up of 9 months, the overall stoma closure rate was 68.9% with a median time to closure of 155 days (range 57-398 days). The complication rate after reversal was 15.5%, with most related to prior ostomy site infection. 26 patients received total parenteral nutrition (TPN) for a median time of 7 days (range 2-30 days) representing a cumulative total of 239 TPN days.

Conclusion/Discussion: Temporary diversion in complex IBD surgical practice is associated with substantial short- and long-term morbidity resulting in the use of a prodigious amount of healthcare resources. However, stoma-related complications remain manageable, and temporary diversion continues to be an important – if not critical - component of mitigating surgical complications in a complex surgical practice. That said, this study provides critical data to support patient counseling, informed decision-making, and targeted resource strategies to minimize diversion-related complications.