The improved outcome of reversal surgery for split stoma with peristomal incision compared to end stoma closure with middle incision in patients with Crohn’s disease

Abstract Background Temporary stoma formation is common in Crohn’s disease (CD), while stoma reversal is associated with postoperative morbidity. This study aimed at evaluating postoperative outcomes of split stoma reversal (SSR) with peristomal incision versus end stoma closure (ESC) with middle incision. Methods Consecutive patients with CD who underwent stoma reversal surgery between 2017 and 2021 were included. Patients’ demography, clinical characteristics, and postoperative outcomes were collected. Date analysis was performed to evaluate the short and long-term outcomes of reversal surgery. Results There were 255 patients who underwent stoma reversal surgeries meeting the inclusion criteria. Split stoma reversal was superior to end stoma closure in operative time, intraoperative blood-loss, incision length and classification, the length of postoperative hospital stay, hospital expense, and postoperative complications ( P < 0.05). Additionally, patients in split stoma reversal showed significant decreased postoperative inflammatory parameters including white blood cell, procalcitonin, and percentage of neutrophils ( P < 0.05). Interestingly, decreased postoperative surgical recurrence was found in patients with split stoma reversal compared to those with end stoma closure (8.3% vs 3.2%). Conclusions In case of stoma construction is indicated in patients with Crohn’s disease undergoing surgical resection, the split stoma is recommended, given that split stoma reversal with peristomal incision is associated with cosmetic outcome, short length of postoperative hospital stay as well as decreased postoperative morbidity.