Complications of loop ileostomy and ileostomy closure and their implications for extended enterostomal therapy: a prospective clinical study.
BACKGROUND
Patients who have a temporary loop ileostomy have impaired quality of life. Complications associated with a loop ileostomy or ileostomy closure will impair patients' quality of life further and require extended enterostomal therapy. We performed a prospective audit of loop ileostomy to ascertain the nature of the workload that may be created with ileostomy-related complications.


METHODS
One hundred and forty patients (67 males, 73 females, median age 50 years, range 5-90 years) who received a temporary loop ileostomy were analysed after completion of proformas on a prospective basis between 1999 and 2006.


RESULTS
Operation was performed for rectal cancer 100 (71%), familial adenomatous polyposis 14 (10%), ulcerative colitis 21 (15%) and for trauma or Hirchsprung's disease 5 (3%). Complications of loop ileostomy were: retraction 1 (0.7%), ileostomy flux 11 (8%), stomal prolapse 1 (0.7%), parastomal hernia 1 (0.7%), paraileostomy abscess 4 (3%) and severe skin excoriation 9 (6%). The loop ileostomy was reversed in 117 (83%) at a median (range) of 13 weeks (1-60). Ileostomy closure-related complications were: small bowel fistula 1 (0.9%), small bowel obstruction 5 (4.3%) and a stitch sinus in 1 (0.9%). Five women developed recto-vaginal fistula (n=3; 2.6%), pouch-vaginal fistula (n=1; 0.9%) and pouch-anal fistula (n=1; 0.9%) that required extended enterostomal therapy, after loop ileostomy reversal.


CONCLUSIONS
Nineteen percent of patients following creation of a loop ileostomy and 10.5% of patients after reversal of the ileostomy required extended enterostomal care by a specialized enterostomal therapist, which supported resumption of a normal life.
Rathnayake
M M G
MM
Department of Surgery, Faculty of Medicine, University of Kelaniya, Sri Lanka. gee2006@yahoo.com
Kumarage
S K
SK
Wijesuriya
S R E
SR
Munasinghe
B N L
BN
Ariyaratne
M H J
MH
Deen
K I
KI
D011125:Adenomatous Polyposis Coli / Q000601:surgery; D003093:Colitis, Ulcerative / Q000601:surgery; D005260:Female; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D046449:Hernia, Abdominal / Q000209:etiology; D006627:Hirschsprung Disease / Q000601:surgery; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects* / Q000451:nursing* / Q000523:psychology; D007412:Intestinal Fistula / Q000209:etiology; D007415:Intestinal Obstruction / Q000209:etiology; D008134:Long-Term Care / Q000458:organization & administration*; D008297:Male; D009720:Nurse Clinicians / Q000458:organization & administration*; D024802:Nurse's Role; D009731:Nursing Audit; D015403:Nursing Evaluation Research; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery; D012006:Rectovaginal Fistula / Q000209:etiology; D012086:Reoperation; D017592:Skin Care / Q000451:nursing; D013530:Surgical Wound Infection / Q000209:etiology; D014624:Vaginal Fistula / Q000209:etiology; D016526:Workload