Clinical utility of a de-functioning loop ileostomy.
BACKGROUND
The de-functioning loop ileostomy was introduced as a technique to create a manageable stoma that would divert the faecal stream from a more distal anastomosis in order to reduce the consequences of any anastomotic leakage. The value of de-functioning stomas is currently being challenged. The purpose of the present study was to review the clinical utility of performing a de-functioning loop ileostomy in patients undergoing colorectal surgery.


METHODS
A review was undertaken of a prospective colorectal database maintained at Fremantle Hospital. All end-points were defined prior to the collection of data. The study reviewed the indications and type of surgery performed. The main end-points included (i) the prevalence and management of anastomotic leaks at the primary surgery; (ii) unplanned readmissions prior to stoma closure; and (iii) the mortality, reoperation rate, and morbidity associated with closure of the stoma.


RESULTS
The study involved 233 patients of mean age 58 years (range 15-89 years) and a male:female ratio of 1.1:1. The majority of patients were undergoing elective surgery (82%) for colorectal neoplasia (71%). The commonest surgical procedure was an ultra-low anterior resection (62%). At the initial surgery, 16 patients (7.0%) developed anastomotic leaks, but only two (0.9%) required reoperation. Eleven patients (4.8%) required 12 unplanned readmissions prior to stoma closure. At closure (n = 230), there were no postoperative deaths, one patient developed an ileal anastomotic leak that was managed with antibiotics, and five patients (2.2%) required reoperation within 30 days of surgery.


CONCLUSIONS
De-functioning loop ileostomy was found to be associated with a relatively low morbidity and no mortality.
Platell
Cameron
C
Colorectal Surgical Unit, Fremantle Hospital, Fremantle, Western Australia, Australia. cplatell@cyllene.uwa.edu.au
Barwood
Nigel
N
Makin
Gregory
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003082:Colectomy / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007081:Ileostomy; D007410:Intestinal Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000209:etiology*; D016896:Treatment Outcome