Closure of loop ileostomies: is early discharge safe and achievable?
A prospective audit of the complications associated with reversal of a loop ileostomy was carried out between March 2000 and March 2005. The complication rate, length of inpatient hospitalisation and re-admission rate were assessed in 100 patients, in a single clinical practice. The median (interquartile range) length of time between the primary procedure and closure was 133 days (120-270) days. Median length of inpatient stay was two days (one - three) days. The overall complication rate was 18%. One patient had a post-operative leak leading to local abscess formation. This was drained surgically after initial failure with radiological drainage. A second patient had a late leak, three weeks after closure, leading to fistula formation. This patient required surgical resection of the anastomosis after failure of conservative management. Twelve patients were re-admitted with small bowel obstruction (12%), of whom 11 were managed conservatively, while one underwent further surgery. There was one post- operative death as a result of acute cardiac failure secondary to undiagnosed hypertensive cardiomyopathy. Thus early discharge following closure of a loop ileostomy, can be achieved with an acceptably low serious complication rate.
Ihedioha
U
U
Department of General Surgery, Monklands Hospital, Airdrie, UK. ugoihedioha@hotmail.com
Muhtaseb
S
S
Kalmar
K
K
Donnelly
L
L
Muir
V
V
Macdonald
A
A
D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007081:Ileostomy; D007410:Intestinal Diseases / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010359:Patient Readmission; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome