title: Impact of defunctioning loop ileostomy on outcome after restorative proctocolectomy for ulcerative colitis.
abstract: OBJECTIVE
  This study analyzes the impact of a temporary loop ileostomy on postoperative outcome after restorative proctocolectomy for ulcerative colitis in terms of complications and reoperations including ileostomy closure.
  
  
  METHODS
  The records of 122 consecutive patients undergoing restorative proctocolectomy for ulcerative colitis during a 12-year period were reviewed. In 89 patients, a defunctioning ileostomy was created, while 33 patients had no ileostomy. Statistics were done with Chi-square test and Mann-Whitney U test, p < 0.05 considered significant.
  
  
  RESULTS
  Both study groups were comparable concerning age, colitis activity, previous diseases, previous surgery, use of steroids, and immunosuppressives. Pouch-related septic complications (anastomotic dehiscence, pouch leakage, pelvic abscess) were significantly lower in the ileostomy group (5.6% vs. 18.2%, p = 0.031), resulting in a lower rate of emergency laparotomies following restorative proctocolectomy (4.5% vs. 30.3%, p < 0.001). Including all complications associated with scheduled closure of ileostomy, the cumulative frequency of emergency laparotomies was significantly lower in the ileostomy group (13.5% vs. 30.3%, p = 0.032). The cumulative duration of hospitalization, including all hospital stays for complications or closure of the ileostomy, was significantly longer in the ileostomy group [median 22 days (11-92) vs. 14 days (9-109), p < 0.001]. During long-term follow-up, a stricture at the pouch-anal anastomosis was more common in the ileostomy group (24.7% vs. 6.1%, p = 0.021), whereas only one stricture necessitated surgical therapy.
  
  
  CONCLUSIONS
  Creation of a defunctioning loop ileostomy reduces pouch-related septic complications and the frequency of emergency second laparotomies after restorative proctocolectomy for ulcerative colitis.
authors.affiliation: Department of General and Visceral Surgery, University Hospital Muenster, Waldeyerstr. 1, 48149 Muenster, Germany. rudolf.mennigen@ukmuenster.de
authors.forename: Rudolf
authors.initials: R
authors.lastname: Mennigen
authors.forename: Norbert
authors.initials: N
authors.lastname: Senninger
authors.forename: Matthias
authors.initials: M
authors.lastname: Bruwer
authors.forename: Emile
authors.initials: E
authors.lastname: Rijcken
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011239:Prednisolone / Q000627:therapeutic use; D016737:Proctocolectomy, Restorative / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D011239:Prednisolone