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Morbidity associated with closure of ileostomy after a three-stage ileal pouch-anal anastomosis

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Abstract

The aim of the study was to compare the perioperative outcomes of patients undergoing ileostomy closure after a three-stage ileal pouch-anal anastomosis to a control group of patients who had elective colorectal resections and stoma, and to analyse the differences based on the technique of closure. The cases were retrospectively compared for demographic characteristics and postoperative outcomes. Chi-square, Fisher’s exact and Wilcoxon rank sum tests were used as appropriate. Between 2011 and 2016, 338 patients having their stoma reversed after three-stage IPAA were compared to 158 patients in the control group. A younger age (43.2 vs 60.6 years, p < 0.0001), a lower body mass index (22 vs 24.4 kg/m2, p < 0.0001), a higher rate of hand-sewn anastomosis (84.3 vs 15.7%, p < 0.0001), a lower rate of intraoperative complications (0 vs 1.2%, p = 0.038), a shorter operative time (91.5 vs 99.4 min, p = 0.0046) and length of hospital stay (6.6 vs 7.6 days, p = 0.045) were seen in the IPAA group. The 30-day rate of wound infection, anastomotic leak (0.6 vs 0.6%), small bowel obstruction (SBO, 8 vs 11.4%) and reoperation (1.8 vs 1.3%) was similar. Among IPAA patients, the hand-sewn anastomosis was correlated with a higher chance of developing SBO (9.1 vs 1.9%, p = 0.03). Closure of ileostomy after three-stage IPAA is associated with low rate of serious complications, despite the higher number of previous abdominal surgeries. This supports the construction of routine ileostomy during IPAA to reduce the risk of pelvic sepsis.

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References

  1. Parks AG, Nicholls RJ (1978) Proctocolectomy without ileostomy for ulcerative colitis. Br Med J 8(2):85–88

    Article  Google Scholar 

  2. Fazio VW, Kiran RP, Remzi FH, Coffey JC, Heneghan HM, Kirat HT, Manilich E, Shen B, Martin ST (2013) Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 257:679–685

    Article  PubMed  Google Scholar 

  3. Hueting WE, Buskens E, van der Tweel I, Gooszen HG, van Laarhoven CJ (2005) Results and complications after ileal pouch anal anastomosis: a meta-analysis of 43 observational studies comprising 9317 patients. Dig Surg 22:69–79

    Article  PubMed  Google Scholar 

  4. Mennigen R, Senninger N, Bruwer M, Rijcken E (2011) Impact of defunctioning loop ileostomy on outcome after restorative proctocolectomy for ulcerative colitis. Int J Colorectal Dis 26:627–633

    Article  PubMed  Google Scholar 

  5. Tulchinsky H, Hawley PR, Nicholls J (2003) Long-term failure after restorative proctocolectomy for ulcerative colitis. Ann Surg 238:229–234

    PubMed  PubMed Central  Google Scholar 

  6. Sahami S, Buskens CJ, Fadok TY, Tanis PJ, de Buck van Overstraeten A, Wolthuis AM, Bemelman WA, D’Hoore A (2016) Defunctioning ileostomy is not associated with reduced leakage in proctocolectomy and ileal pouch anastomosis surgeries for IBD. J Crohns Colitis 10:779–785

    Article  PubMed  Google Scholar 

  7. Grobler SP, Hosie KB, Keighley MR (1992) Randomized trial of loop ileostomy in restorative proctocolectomy. Br J Surg 79:903–906

    Article  CAS  PubMed  Google Scholar 

  8. Ikeuchi H, Nakano H, Uchino M, Nakamura M, Noda M, Yanagi H, Yamamura T (2005) Safety of one-stage restorative proctocolectomy for ulcerative colitis. Dis Colon Rectum 48:1550–1555

    Article  PubMed  Google Scholar 

  9. Mennigen R, Sewald W, Senninger N, Rijcken E (2014) Morbidity of loop ileostomy closure after restorative proctocolectomy for ulcerative colitis and familial adenomatous polyposis: a systematic review. J Gastrointest Surg 18:2192–2200. https://doi.org/10.1007/s11605-014-2660-8

    Article  PubMed  Google Scholar 

  10. Löffler T, Rossion I, Bruckner T, Diener MK, Koch M, von Frankenberg M, Pochhammer J, Thomusch O, Kijak T, Simon T, Mihaljevic AL, Krüger M, Stein E, Prechtl G, Hodina R, Michal W, Strunk R, Henkel K, Bunse J, Jaschke G, Politt D, Heistermann HP, Fußer M, Lange C, Stamm A, Vosschulte A, Holzer R, Partecke LI, Burdzik E, Hug HM, Luntz SP, Kieser M, Büchler MW, Weitz J, HASTA Trial Group (2012) HAnd Suture Versus STApling for closure of loop ileostomy (HASTA Trial): results of a multicenter randomized trial (DRKS00000040). Ann Surg 256:828–835. https://doi.org/10.1097/sla.0b013e318272df97

    Article  PubMed  Google Scholar 

  11. Gong J, Guo Z, Li Y, Gu L, Zhu W, Li J, Li N (2013) Stapled vs hand suture closure of loop ileostomy: a meta-analysis. Colorectal Dis 15:561–568. https://doi.org/10.1111/codi.12388

    Article  Google Scholar 

  12. Löffler T, Rossion I, Gooßen K, Saure D, Weitz J, Ulrich A, Büchler MW, Diener MK (2015) Hand suture versus stapler for closure of loop ileostomy—a systematic review and meta-analysis of randomized controlled trials. Langenbecks Arch Surg 400:193–205. https://doi.org/10.1007/s00423-014-1265-8

    Article  PubMed  Google Scholar 

  13. Hull TL, Kobe I, Fazio VW (1996) Comparison of handsewn with stapled loop ileostomy closures. Dis Colon Rectum 39:1086–1089

    Article  CAS  PubMed  Google Scholar 

  14. Hasegawa H, Radley S, Morton DG, Keighley MR (2000) Stapled versus sutured closure of loop ileostomy: a randomized controlled trial. Ann Surg 231:202–204

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  16. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381

    Article  Google Scholar 

  17. Heuschen UA, Hinz U, Allemeyer EH, Lucas M, Heuschen G, Herfarth C (2001) One- or two-stage procedure for restorative proctocolectomy: rationale for a surgical strategy in ulcerative colitis. Ann Surg 234:788–794

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Weston-Petrides GK, Lovegrove RE, Tilney HS, Heriot AG, Nicholls RJ, Mortensen NJ, Fazio VW, Tekkis PP (2008) Comparison of outcomes after restorative proctocolectomy with or without defunctioning ileostomy. Arch Surg 143:406–412

    Article  PubMed  Google Scholar 

  19. Gu J, Remzi FH, Shen B, Vogel JD, Kiran RP (2013) Operative strategy modifies risk of pouch-related outcomes in patients with ulcerative colitis on preoperative anti-tumor necrosis factor-α therapy. Dis Colon Rectum 56:1243–1252

    Article  PubMed  Google Scholar 

  20. Fazio VW, Tekkis PP, Remzi F, Lavery IC, Manilich E, Connor J, Preen M, Delaney CP (2003) Quantification of risk for pouch failure after ileal pouch anal anastomosis surgery. Ann Surg 238:605–614

    PubMed  PubMed Central  Google Scholar 

  21. Kiely JM, Fazio VW, Remzi FH, Shen B, Kiran RP (2012) Pelvic sepsis after IPAA adversely affects function of the pouch and quality of life. Dis Colon Rectum 55:387–392

    Article  PubMed  Google Scholar 

  22. Gardenbroek TJ, Musters GD, Buskens CJ, Ponsyoen CY, D’Haens GR, Dijkgraaf MG, Tanis PJ, Bemelman WA (2015) Early reconstruction of the leaking ileal pouch-anal anastomosis: a novel solution to an old problem. Colorectal Dis 17:426–432

    Article  CAS  PubMed  Google Scholar 

  23. Chow A, Tilney HS, Paraskeva P, Jeyarajah S, Zacharakis E, Purkayastha S (2009) The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6107 cases. Int J Colorectal Dis 24:711–723

    Article  PubMed  Google Scholar 

  24. Barmparas G, Branco BC, Schnüriger B, Lam L, Inaba K, Demetriades D (2010) The incidence and risk factors of post-laparotomy adhesive small bowel obstruction. J Gastrointest Surg 14:1619–1628

    Article  PubMed  Google Scholar 

  25. Bueno-Lledó J, Barber S, Vaqué J, Frasson M, Garcia-Granero E, Juan-Burgueño M (2016) Adhesive small bowel obstruction: predictive factors of lack of response in conservative management with gastrografin. Dig Surg 33:26–32

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

REDCap (Research Electronic Data Capture) is a secure, web-based application designed to support data capture for research studies, providing: (1) an intuitive interface for validated data entry; (2) audit trails for tracking data manipulation and export procedures; (3) automated export procedures for seamless data downloads to common statistical packages; and (4) procedures for importing data from external sources.

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No funding was received for the present study.

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Authors and Affiliations

  1. Surgery of the Alimentary Tract, Department of Medical and Surgical Sciences, Sant’Orsola, Malpighi Hospital, Alma Mater Studiorum University of Bologna, Via Massarenti 9, 40138, Bologna, Italy

    Matteo Rottoli, Benedetta Casadei, Carlo Vallicelli, Giulia Vitali, Federico Ghignone, Marica Melina, Marta Tanzanu & Gilberto Poggioli

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  1. Matteo Rottoli
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  2. Benedetta Casadei
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  3. Carlo Vallicelli
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  4. Giulia Vitali
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  5. Federico Ghignone
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  6. Marica Melina
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  7. Marta Tanzanu
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  8. Gilberto Poggioli
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Correspondence to Matteo Rottoli.

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The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in the present study involving human being were in accordance with the ethical standards of the institutional and national research committee and with 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was signed by all patients.

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Rottoli, M., Casadei, B., Vallicelli, C. et al. Morbidity associated with closure of ileostomy after a three-stage ileal pouch-anal anastomosis. Updates Surg 71, 533–537 (2019). https://doi.org/10.1007/s13304-018-0594-5

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  • DOI: https://doi.org/10.1007/s13304-018-0594-5

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