title: An institutional comparison of total abdominal colectomy and diverting loop ileostomy and colonic lavage in the treatment of severe, complicated Clostridium difficile infections.
abstract: BACKGROUND
  Total abdominal colectomy (TAC) is the standard surgical treatment of Clostridium difficile infection (CDI). An alternative therapy, loop ileostomy and colonic lavage (IL), was described in 2011, but the results have never been validated.
  
  
  METHODS
  Patients treated surgically for CDI between April 2011 and June 2015 were included. Bivariable analysis was used to compare 30-day mortality, 1-year mortality, CDI recurrence, colon preservation and ileostomy reversal.
  
  
  RESULTS
  Ten IL patients and thirteen TAC patients were identified. 30-day mortality (30% vs 23%, p = 1.0) and 1-year mortality (40% vs 46%, p = 1.0) were similar. Four IL and three TAC patients (57% vs 30%, p = 0.35) experienced recurrent CDI. All six surviving IL patients had successful colon preservation; five underwent ileostomy reversal compared to three in the TAC group (83% vs 43%, p = 0.27).
  
  
  CONCLUSIONS
  Although IL allowed colon preservation and return of intestinal continuity in most patients, IL did not decrease mortality or recurrent CDI when compared to TAC.
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: Anna Z
authors.initials: AZ
authors.lastname: Fashandi
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: Allison N
authors.initials: AN
authors.lastname: Martin
authors.affiliation: Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: Patty T
authors.initials: PT
authors.lastname: Wang
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: Traci L
authors.initials: TL
authors.lastname: Hedrick
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Friel
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: Philip W
authors.initials: PW
authors.lastname: Smith
authors.affiliation: Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: R Ann
authors.initials: RA
authors.lastname: Hays
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA. Electronic address: pth2f@virginia.edu.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Hallowell
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003015:Clostridium Infections / Q000401:mortality / Q000628:therapy*; D003082:Colectomy / Q000379:methods*; D003106:Colon; D005260:Female; D006801:Humans; D007081:Ileostomy; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D059351:Organ Sparing Treatments; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D007507:Therapeutic Irrigation; D014640:Vancomycin / Q000627:therapeutic use; D014768:Virginia / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D014640:Vancomycin
keywords: C. difficile; Clostridium difficile; Colectomy; Loop ileostomy and colonic lavage; Total abdominal colectomy