Protective loop‐ileostomy in ileal pouch–anal anastomosis for ulcerative colitis – advantages and disadvantages. A retrospective study

Abstract

Aim The aim was to investigate the overall postoperative complication rate within 90 days following ileal pouch–anal anastomosis (IPAA), with or without a diverting stoma, together with complications 30 days after stoma closure and overall pouch failure rate. Method This was a retrospective chart review including IPAA patients with or without a diverting loop‐ileostomy for ulcerative colitis (1 January 1983 to 31 December 2015). Demographic data and postoperative complications were retrieved and recorded. Results A total of 434 patients were included. A diverting loop‐ileostomy was performed in 348 patients (80%). Baseline data were similar in the two groups except for body mass index (BMI) and the ratio of women, which were significantly higher in the group without a protective ileostomy. Overall 90‐day complication rate after IPAA [Clavien–Dindo (CD) > 2] was similar in the two groups. Clinical anastomotic leaks (CD > 2) were higher in patients without a diverting stoma (9.3% vs 1.7%) (P = 0.002). The odds ratio for leakage after adjustments (age, gender, immune‐modulating medicine and BMI) was 5.0 for omitting a diverting stoma (P = 0.004). Complications (CD > 2) after loop‐ileostomy closure were seen in 61 cases (14.1%). Omitting a diverting stoma at IPAA demonstrated a non‐significant odds ratio of 1.04 (0.46, 2.38) (P = 0.924) for pouch failure after adjustments (age, gender, immune‐modulating medicine, BMI, time from pouch formation and clinical leakage). Conclusion The overall postoperative surgical and medical complication rate within 90 days after IPAA was similar in the group with and without diverting stoma. Postoperative complication rate after reversal was 14%. Omitting a diverting stoma at IPAA demonstrated an increased risk of leaks but no significant risk of long‐term pouch failure.

Postoperative complications of colectomy and J-pouch with ileostomy versus without ileostomy in children with inflammatory bowel diseases: a systematic review and meta-analysis

“…In the adult literature, anastomotic leak rates range from 5% to 19%,42–44 and there seems to be a trend towards decreased clinically detectable leak rates in the diverted versus undiverted group 23. This finding does not align with previous literature reporting higher incidence of anastomotic leakage in the undiverted than diverted populations 42 45–48…”

Early Postoperative Complications and Surgical Anatomy After Ileostomy Reversal Among the Population of Khyber Pakhtunkhwa, Pakistan

“…Intestinal obstruction (32.6%), diarrhea (6%), abdominal incision infection (6%), enterocutaneous fistula (4.5%), rectorrhagia (3.4%), and anastomotic leak (3.4%) were the most common consequences (1.12%). The average length of stay for patients was 7.54 (2-23) days [ 6 ]. In another study, overall, complications occurred in 21.5%, including 4.8% patients who experienced a major complication; there were no deaths within 30 days [ 12 ].…”

“…After obtaining the ethical approval from the Institutional Ethical Review Board (IERB) of Nowshera Medical College, this study was conducted for six months from 01/01/2021 to 30/06/2021. A total of 241 was the sample size which was calculated through WHO formula for sample size calculation by taking 6% [ 6 ], the prevalence of surgical wound infection after ileostomy closure, confidence interval is 95%, and margin of error is 5% with a p-value of ≤0.05 taken as significant. Non-probability consecutive sampling method was employed in the analysis.…”

“…The normal intestinal path is re-established after the loop ileostomy is closed, which is usually after 90 days [5]. Wound infection/hematoma, leaking from the anastomosis following reversal, small intestinal blockage at the site of ileostomy closure, iatrogenic bowel injuries, local abscess, and post reversal peristomal dermatitis are all reported postoperative issues linked with stoma closure [6,7]. The reversal has been linked to a variety of morbidity rates, according to different authors [8][9][10].…”

Prolonged diversion after ileal pouch‐anal anastomosis: Is it safe to wait?

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Ileal pouch-anal anastomosis (IPAA) provides restoration of intestinal continuity following proctocolectomy. Anastomotic leak and pelvic sepsis can occur in up to 15% of patients with associated major long term effects including pouch failure [1,2]. The risk of symptomatic leak is decreased by formation of a proximal stoma and the procedure is typically performed with a diverting loop ileostomy (DLI).

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