title: Does Diverting Loop Ileostomy Improve Outcomes Following Open Ileo-Colic Anastomoses? A Nationwide Analysis.
abstract: Anastomotic leak is one of the most feared complications of gastrointestinal surgery. Surgeons routinely perform a diverting loop ileostomy (DLI) to protect high-risk colo-rectal anastomoses.
  
  
  
  The NSQIP database was queried from 2012 to 2013 for patients undergoing open ileo-colic resection with and without a DLI. The primary outcome was the development of any anastomotic leak-including those managed operatively and non-operatively. Secondary outcomes included overall complication rate, return to the OR, readmission, and 30-day mortality.
  
  
  
  Four thousand one hundred fifty-nine patients underwent open ileo-colic resection during the study period. One hundred eighty-six (4.5 %) underwent a DLI. Factors associated with the addition of a DLI included emergency surgery, pre-operative sepsis, and IBD. There were 197 anastomotic leaks (4.7 %) with 100 patients requiring reoperation (2.4 %). DLI was associated with a decrease in anastomotic leaks requiring reoperation (DLI vs no DLI: 0 (0 %) vs 100 (2.5 %); p = 0.02) and with increased readmission (OR 1.93; 95 % CI 1.30-2.85; p = 0.001).
  
  
  
  DLI is rarely used for open ileo-colic resection. There were no serious leaks requiring reoperation in the DLI group. A DLI was associated with an almost two-fold increase in the odds of readmission. Surgeons must weigh the reduction in serious leak rate with postoperative morbidity when considering a DLI for open ileo-colic resection.
authors: Department of Surgery, Section of Colon and Rectal Surgery, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA.
authors: Alexander T
authors: AT
authors: Hawkins
authors: Department of Surgery, Section of Colon and Rectal Surgery, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA.
authors: Sekhar
authors: S
authors: Dharmarajan
authors: Department of Surgery, Section of Colon and Rectal Surgery, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA.
authors: Katerina K
authors: KK
authors: Wells
authors: Department of Surgery, Section of Colon and Rectal Surgery, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA.
authors: Devi Mukkai
authors: DM
authors: Krishnamurty
authors: Department of Surgery, Section of Colon and Rectal Surgery, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA.
authors: Matthew G
authors: MG
authors: Mutch
authors: Department of Surgery, Section of Colon and Rectal Surgery, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA. glasgows@wustl.edu.
authors: Sean C
authors: SC
authors: Glasgow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control*; D003106:Colon / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Anastomotic leak; Colorectal surgery; Diverting loop ileostomy; Ileo-colic anastomosis