title: The outcome after restorative proctocolectomy with or without defunctioning ileostomy.
abstract: OBJECTIVE
  Controversy exists regarding the safety for omission of diverting ileostomy in restorative proctocolectomy because of fears of increased septic complications. This study was designed to evaluate the outcomes of restorative proctocolectomy in a consecutive series of patients by comparing postoperative complications, functional results, and quality of life in patients with and without diverting ileostomy.
  
  
  METHODS
  Data regarding demographics, length of stay, surgical characteristics, and complications were reviewed and recorded according to the presence (n= 1,725) or absence (n = 277) of a diverting ileostomy at the time of pelvic pouch surgery. Criteria for omission of ileostomy included: stapled anastomosis, tension-free anastomosis, intact tissue rings, good hemostasis, absence of airleaks, malnutrition, toxicity, anemia, and prolonged consumption of steroids. Functional outcome and quality of life indicators were prospectively recorded and compared.
  
  
  RESULTS
  Patients in the ileostomy group had greater body surface area and older mean age at time of surgery, were taking greater doses of steroids preoperatively, and required more blood transfusions at the time of surgery compared with the one-stage (P < 0.05). There were no differences between the two groups in septic complications (P > 0.05). Early postoperative ileus was more common in the one-stage group (P < 0.001). There were no differences between the groups in quality of life and functional outcomes.
  
  
  CONCLUSIONS
  For carefully selected patients undergoing restorative proctocolectomy with ileal pouch-anal anastomosis, omission of diverting ileostomy is a safe procedure that does not lead to an increase in septic complications or mortality. Quality of life and functional results are similar to those who undergo ileal pouch-anal anastomosis with diversion, provided that certain selection factors are considered.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. remzif@ccf.org
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
authors.forename: Victor W
authors.initials: VW
authors.lastname: Fazio
authors.forename: Emre
authors.initials: E
authors.lastname: Gorgun
authors.forename: Boon S
authors.initials: BS
authors.lastname: Ooi
authors.forename: Jeff
authors.initials: J
authors.lastname: Hammel
authors.forename: Miriam
authors.initials: M
authors.lastname: Preen
authors.forename: James M
authors.initials: JM
authors.lastname: Church
authors.forename: Khaled
authors.initials: K
authors.lastname: Madbouly
authors.forename: Ian C
authors.initials: IC
authors.lastname: Lavery
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000328:Adult; D039021:Colonic Pouches; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects; D015212:Inflammatory Bowel Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000009:adverse effects; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome