The value of diverting loop ileostomy on the high-risk colon and rectal anastomosis.
BACKGROUND
The need for diverting loop ileostomies to protect high-risk anastomoses has been questioned recently by several authors. This study was designed to evaluate the potential benefits and complications of diverting loop ileostomies in a high-risk anastomosis population.


METHODS
Ninety-four consecutive patients undergoing diverting loop ileostomy were evaluated from a prospective database between 2003 and 2006. Criteria for diversion were: anastomosis less than 5 cm from the anal verge, previous pelvic radiation therapy, obstruction, and infection. Data regarding patient demographics, underlying pathology, anastomotic problems, and ileostomy-related problems were gathered.


RESULTS
Indications for surgery were malignancy (n = 40), ulcerative colitis (n = 37), acute diverticulitis (n = 12), perirectal fistulas (n = 3), and familial polyposis (n = 2). There were 5 anastomotic complications. One required permanent stoma and 4 required delay in diverting ileostomy closure but no other intervention. Ileostomy-related problems were limited to minor stoma and pouch complaints requiring stoma nurse evaluation (n = 23), dehydration requiring outpatient (n = 8) or inpatient (n = 4) intravenous fluids, stricture at stoma closure site (n = 2), and bleeding at stoma closure site (n = 1). Four stoma site hernias (4.3%) have been identified to date.


CONCLUSIONS
The use of diverting loop ileostomy in patients undergoing colon and rectal surgery with high-risk anastomoses is beneficial. Their selected use has resulted in a 1% anastomotic loss rate with an acceptably low rate of complications related to the ileostomy.
Bax
Timothy W
TW
Surgical Specialists of Spokane, 105 W. 8th Avenue, Suite 7060, Spokane, WA 99203, USA. drtbax@comcast.net
McNevin
M Shane
MS
D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery*; D003108:Colonic Diseases / Q000601:surgery*; D003110:Colonic Neoplasms / Q000601:surgery*; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012307:Risk Factors