De-functioning loop ileostomy: creating more problems from solving one?




Background and aims: De-functioning loop ileostomies are used currently in anterior resection to reduce the consequences of anastomotic leak. However, this practice remains controversial as the complication associated with the de-functioning stoma has been overlooked. The objectives of this paper were to study the complication associated with de-functioning loop ileostomy in the patient undergoing an anterior resection.

Method: Patient sample identification obtained from local colorectal registry and data reviewed retrospectively. Only anterior resection with or without de-functioning loop ileostomy for the indication of rectal cancer or pre-cancerous polyps were included. 150 patients satisfied the inclusion criteria. Statistical analysis of Chi-square test was applied for twogroup comparisons of categorical data and Mann Whitneyfor continuous numerical variables.

Results: Overall, 50% of 74 patients in the stoma group had stoma-related complication either acutely or later that resulted in unplanned re-admission with re-admission rate of 17.6%. Closure rate was 77%, with a mean interval of 7.4 months. A further 28% (16 of 57) of the reversed groupexperienced complications. Combined length of stay after anterior resection and reversal surgery was 19.3 days vs. 8.1 days in the non-stoma group (p=0.001).

Conclusion: The creation of de-functioning loop ileostomy is associated with a significantly increased risk of stoma-related morbidity with low anterior resection. The perceived benefits and risks of routine creation of de-functioning loop ileostomy in anterior resection should be reconsidered while planning for surgery and only selective of suitable candidates that are of high risk of severe anastomotic leak.


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