S‐III‐02 Construction and Management of Loop Ileostomy

Abstract

Aim: The aim of this study was to determine the morbidity associated with both construction and reversal of loop ileostomies. Methods: Thirty‐three patients who had loop ileostomies constructed and 31 of these same patients who had their loop ileostomies reversed between 1994 and 2001 were reviewed.The loop ileostomies were constructed in round‐shaped (2.5∼3 cm in diameter) like a end ileostomy and everted to produce a 2∼3 cm stoma without a rod Results: The average size of ileostomies was 28 × 29 × 25(hight)mm. Five patients had complications arising from ileostomy construction including 4 parastomal irritation, 1 ileus, and 1 stomal ulcer. All complications improved with conservative management. Mean time to ileostomy reversal was 78 days. Of 31 patients who had loop ileostomies reversed, 10 patients had staple closure (functional end‐to‐end anastomosis with ENDO GIA 45). Nine patients had complications associated with reversal including 6 small bowel obstruction due to anastomotic stenosis(anastomotic edema), 1 leakage and 2 SIRS. Of these 9 patients, 2 required surgical intervention. One patient suffered leakage required reanastomosis, one for SIRS required reconstruction of loop ileostomy. Of 6 patients developed small bowel obstruction, 3 required long intestinal tube decompression. All patients improved with conservative management. 10 patients who had their loop ileostomies closed by functional end‐to‐end anastomosis had no bowel obstruction and other complications. Conclusions: Defunctioning loop ileostomy is associated with low morbidity. We recommend a defunctioning ileostomy as the procedure of choice for temporary fecal diversion, and functional end‐to‐end anastomosis in reversal of ileostomies.