Feasibility and outcome of proximal catheter ileostomy - A pilot study

Abstract

Background/Aim:Loop ileostomy has high complication rates and causes much patient inconvenience. This study was carried out to evaluate the feasibility and outcome of a proximal catheter ileostomy in place of loop ileostomy in patients treated by intestinal repair and/or resection-anastomosis.Design: Prospective study.Setting: J. N. Medical College Hospital, Aligarh Muslim University, Aligarh, India.Patients and Methods:From November 2006 to November 2009, in all patients treated surgically by primary repair and/or resection-anastomosis of small and/or large bowel, we constructed a catheter ileostomy when a defunctioning proximal protective loop ileostomy was considered advisable. Catheter ileostomy was constructed in the fashion of catheter jejunostomy, with postoperative saline irrigation.Results:Catheter ileostomy was performed in 20 patients in the 3-year period. The mean age of the subjects was 28.6 years and the male: female ratio was 1.86:1. Four patients died of septicemia and multiple organ failure unrelated to catheter ileostomy in the immediate postoperative period. Catheter ileostomy started functioning within 48 hours of the operation, and twice-daily irrigation was found sufficient in 81.25% of the surviving patients. Only one patient developed peritubal leak with mild skin excoriation that cleared within 5 days. Another patient with Koch's abdomen underwent conversion to loop colostomy on re-exploration for postoperative adhesive obstruction. There was no instance of intestinal leak. Ileostomy wounds closed spontaneously within 7–14 days of catheter removal, and none required formal closure. Hospital stay ranged from 12–35 days (mean: 23 days).Conclusions:Catheter ileostomy is effective in protecting intestinal anastomosis/repair; there is minimal morbidity and no catheter-related leak/mortality, and we recommend the procedure.

Completely diverted tube ileostomy compared with loop ileostomy for protection of low colorectal anastomosis: a pilot study

“…The patients in the CDTI group could therefore be safely discharged as early as the patients in the LI group and did not require any further operation, however, the patients in the CDTI group needed an additional 12.3 days on average for the stoma to close up after tube removal. Peritubal leakage, which has been reported , was not observed in our study. We feel, however, that patients about to have CDTI should undergo on‐table colon washout when the bowel preparation is poor; this also applies to LI .…”

“…, in a study of intubated ileostomy, observed that defaecation began to occur after about 8 days. Transcaecal or non‐transcaecal intubated ileostomy techniques have been reported, but in the case of leakage open conversion to a conventional LI has been necessary in view of the development of faecal peritonitis.…”

“…Completely diverted tube ileostomy compared with loop ileostomy ileostomy, observed that defaecation began to occur after about 8 days. Transcaecal [5][6][7] or non-transcaecal [9,11,12] intubated ileostomy techniques have been reported, but in the case of leakage open conversion to a conventional LI has been necessary in view of the development of faecal peritonitis. The present technique used the temporary occlusion of the lumen of the distal ileum by a single line of staples to prevent early flow of faeces to the anastomotic region.…”

A new technique of completely diverted tube ileostomy for the protection of colorectal anastomosis: a pilot study

“…Therefore, the occlusion by rubber strips was maintained for 2 weeks in this study. Furthermore, in previous studies involving cases of anastomotic leakage, it has been shown that patients have undergone intubated ileostomy without occlusion; conversion to a conventional loop ileostomy has been considered to be necessary in the light of a possible development of faecal peritonitis . However, in this study, tube ileostomy with occlusion was performed; thus, no peritonitis was observed in any patients.…”

A Modified Spontaneously Closed Defunctioning Tube Ileostomy After Anterior Resection of the Rectum for Rectal Cancer with a Low Colorectal Anastomosis

“…In 1993, Winslet et al [11] used transcecal ileal diversion with a 28F Foley catheter to defunction an elective distal colonic anastomosis and achieved satisfactory results. In 2011, Ansari et al [12] retrospectively reviewed 20 patients with tube ileostomy in the 3year period and concluded that tube ileostomy was effective and safe in protecting intestinal anastomosis/repair. In 2012, Rondelli et al [2] retrospectively compared conventional loop Fig.…”