Temporary loop ileostomy for restorative proctocolectomy

Abstract

The aim of a defunctioning ileostomy after restorative proctocolectomy is to mitigate the consequences of pelvic sepsis, should it occur. However, there are complications related to the ileostomy itself. Of 310 patients (174 male and 136 female; mean age 33.2 years) who underwent restorative proctocolectomy between 1976 and 1990, 296 had a covering ileostomy and 14 did not. The stoma has been closed in 263 (88.9 per cent) at a median interval from formation of 12.0 weeks. Ileostomy-related complications before closure occurred in 17 patients (5.7 per cent). Laparotomy for obstruction due to the ileostomy was required in seven patients (2.4 per cent). Retraction requiring revision occurred in three patients (1.0 per cent), an abscess behind the stoma in one (0.3 per cent) and miscellaneous appliance problems in seven (2.4 per cent). Following closure, 59 patients overall (22.4 per cent) developed an ileostomy-related complication. There were 30 cases of small bowel obstruction, treated conservatively in 19 (7.2 per cent) and by laparotomy in 11 (4.2 per cent). Peritonitis requiring laparotomy occurred in three patients (1.1 per cent) and two (0.8 per cent) developed an enterocutaneous fistula. There were 14 (5.3 per cent) wound infections and 16 (6.1 per cent) other miscellaneous problems. Significant complications associated with a temporary ileostomy were less frequent in this series than in some other reports. Obstruction was the most common complication and fistula was rare.

Morbidity of Temporary Loop Ileostomies

“…In this retrospective series, most of the temporary loop ileostomies (87%) were closed, which is in line with other reports [16, 18, 20, 22]. However, after construction of the ileostomy, many patients (42%) experienced stoma-related complications.…”

“…The percentage of patients who suffered from complications (18%) due to the ileostomy closure is in line with previous reports [5, 9, 16, 17, 22]. During follow-up, 5 incisional hernias (8%) at the site of the previous stoma were seen.…”

“…All ileostomies were intended to be closed within 8–12 weeks [16, 20, 22]. Although biased by the retrospective nature of this study, no specific medical reason for this delay was found in the majority of the patients.…”

“…A loop ileostomy probably does not reduce the incidence of anastomotic leakage, but rather decreases the detrimental effects once leakage occurs [10, 11, 12, 13, 14]. In general, closure is not planned earlier than 8–12 weeks after construction [15, 16, 17]. Because ileostomy closure does not have a high medical priority in an era of stringent financial budgeting, this operation is often postponed [5].…”

Operationstechniken bei chronisch entzündlichen Darmerkrankungen

“…Die prophylaktische Ileostomaanlage war unter der Annahme, einen sicheren Heilungsprozess der ileoanalen Pouch-Anastomose zu gewährleisten, eingeführt worden [43]. Studien konnten jedoch zeigen, dass die Heilung der Anastomose unabhängig von der Stuhldeviation durch ein Ileostoma ist [44]. In einer erst kürzlich veröffentlichten prospektiven Studie konnten ebenfalls keine Vorteile hinsichtlich der Komplikationsrate (Anastomoseninsuffizienz, Sepsis, Pouchitis) beobachtet werden [45] [52].…”