The Operative Morbidity in Creation and Closure of Loop Ileostomy

Abstract

Background. The de-functioning loop ileostomy was introduced as a technique to create a stoma that could divert the fecal stream from a more distal anastomosis in order to reduce the consequences of any anastomotic leakage or decompress a distal malignant tumor obstruction. However, the clinical value of this procedure is still being challenged. This study aimed to review the clinical utility of performing a diverting loop ileostomy in patients undergoing colorectal surgery and associated morbidity and mortality. Methods. A retrospective chart review was undertaken of a colorectal database at Veterans General Hospital, Taichuang. The indications and types of operation performed were reviewed. The main end-points included: (1) the incidence of sotma-related complications between creation and closure of loop ileostomy; (2) the mortality rate, re-operation rate, and morbidity associated with closure of the stoma. This review took data from Jan 01, 2003 to Dec 31, 2005, with a total of 203 patients receiving procedures for diverting loop ileostomy. The majority of patients received operations for colorectal cancer. The procedures included total mesorectal excision with coloanal anastomosis, low anterior resection, emergent decompression and reversal of Hartmann's procedure. Results. 144 patients (70.93%) received closure of loop ileostomy and the other 59 patients (29.07%) did not receive closure of loop ileostomy. After creation of a diverting loop ileostomy, electrolyte imbalance/dehydration was seen in 22 patients (10.83%), severe peristomal dermatitis in 4 patients (1.97%), peristomal bleeding in 1 patient (0.49%) and intestinal obstruction in 1 patient (0.49%). After closure of ileostomy, 3 patients (2.08%) developed anastomotic leakage, 3 patients (2.08%) developed wound infections, 2 patients (1.38%) developed distal obstruction and 1 patient (0.69%) developed a pelvic abscess. Conclusions. Creation and closure of the diverting loop ileostomy is associated with no mortality was seen in patients undergoing colorectal surgery in our study.