Temporary loop end ileostomy reduces the risk of stoma outlet obstruction: a comparative clinical study in patients undergoing restorative proctocolectomy and ileal pouch-anal anastomosis.

Abstract

Stoma outlet obstruction (SOO) is a serious complication of restorative proctocolectomy (RPC) and ileal pouch-anal anastomosis (IPAA). When the ileal mesentery to the pouch is under excessive tension, the ileum near the ileostomy twists easily, causing SOO. Loop-end ileostomy (EI) for fecal diversion was introduced in 2021 to prevent SOO, and we aimed to verify whether temporary EI reduces the incidence of SOO in RPC and IPAA patients relative to loop ileostomy (LI). This study included 106 consecutive RPC and IPAA patients with a diverting ileostomy and categorized them into LI (n = 75) or EI (n = 31) groups. The clinical characteristics of the patients were analyzed and compared. Patient characteristics were similar between the groups, except for higher preoperative steroid use in the LI group (38.7%; p = 0.0116). There were no significant differences between the groups in anatomical factors, such as abdominal wall thickness and the height-adjusted distance between the root of the superior mesenteric artery and the bottom of the external anal sphincter. There were no significant differences in surgery-related factors, with ≥ 90% of the patients in each group undergoing laparoscopic procedures. A multivariate logistic regression analysis revealed that EI significantly reduced the risk of SOO relative to LI (OR, 0.18; 95% CI 0.03-0.92; p = 0.0399). EI reduced SOO levels after RPC and IPAA and may be beneficial for cases in which anastomosis is challenging.