Systematic review with meta-analysis: faecal diversion for management of perianal Crohn's disease

Aliment Pharmacol Ther. 2015 Oct;42(7):783-92. doi: 10.1111/apt.13356. Epub 2015 Aug 11.


Background: Temporary faecal diversion is sometimes used for management of refractory perianal Crohn's disease (CD) with variable success.

Aims: To perform a systematic review with meta-analysis to evaluate the effectiveness, long-term outcomes and factors associated with success of temporary faecal diversion for perianal CD.

Methods: Through a systematic literature review through 15 July 2015, we identified 16 cohort studies (556 patients) reporting outcomes after temporary faecal diversion. We estimated pooled rates [with 95% confidence interval (CI)] of early clinical response, attempted and successful restoration of bowel continuity after temporary faecal diversion (without symptomatic relapse), and rates of re-diversion (in patients with attempted restoration) and proctectomy (with or without colectomy and end-ileostomy). We identified factors associated with successful restoration of bowel continuity.

Results: On meta-analysis, 63.8% (95% CI: 54.1-72.5) of patients had early clinical response after faecal diversion for refractory perianal CD. Restoration of bowel continuity was attempted in 34.5% (95% CI: 27.0-42.8) of patients, and was successful in only 16.6% (95% CI: 11.8-22.9). Of those in whom restoration was attempted, 26.5% (95% CI: 14.1-44.2) required re-diversion because of severe relapse. Overall, 41.6% (95% CI: 32.6-51.2) of patients required proctectomy after failure of temporary faecal diversion. There was no difference in the successful restoration of bowel continuity after temporary faecal diversion in the pre-biological or biological era (13.7% vs. 17.6%, P = 0.60), in part due to selection bias. Absence of rectal involvement was the most consistent factor associated with restoration of bowel continuity.

Conclusions: Temporary faecal diversion may improve symptoms in approximately two-thirds of patients with refractory perianal Crohn's disease, but bowel restoration is successful in only 17% of patients.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Anus Diseases / epidemiology
  • Anus Diseases / pathology
  • Anus Diseases / surgery*
  • Colectomy / adverse effects
  • Colectomy / statistics & numerical data
  • Crohn Disease / epidemiology
  • Crohn Disease / pathology
  • Crohn Disease / surgery*
  • Feces
  • Humans
  • Ileostomy* / adverse effects
  • Ileostomy* / methods
  • Ileostomy* / rehabilitation
  • Ileostomy* / statistics & numerical data
  • Proctocolectomy, Restorative / statistics & numerical data
  • Recurrence