World Journal of Surgery

, Volume 32, Issue 9, pp 2101–2106 | Cite as

Complications of Loop Ileostomy Closure: A Retrospective Cohort Analysis of 123 Patients

  • S. D. Mansfield
  • C. Jensen
  • A. S. Phair
  • O. T. Kelly
  • S. B. Kelly
Article

Abstract

Background

Loop ileostomies are often formed in order to defunction distal anastomoses. The aim of this study was to review the complications following closure of loop ileostomies.

Methods

This is a retrospective case note analysis of all loop ileostomy closures performed in the Northumbria Healthcare NHS Trust (population over 500,000) over a 5-year period between 2001 and 2005.

Results

A total of 123 case records were reviewed. Complications occurred in 41 patients (33.3%), with 9 patients (7.3%) requiring further intervention. There were 4 (3.3%) postoperative deaths. Complications were more common in patients with increased comorbidity (p = 0.0007) and postoperative death was more frequent among the elderly (p = 0.0006). Postoperative death was more common in those patients who had their stomas created during surgery (elective or emergency) for diverticular disease (3 patients, p = 0.006). Patients with diverticular disease had significantly higher comorbidity and peritoneal contamination at the time of primary surgery. Ileostomy reversal after anterior resection for cancer was associated with a lower complication rate than the rest of the cohort (26%, p = 0.0003) but there was no significant difference in mortality. Neither the grade of the surgeon, the case volume, or the anastomotic technique affected postoperative morbidity. Reoperation was more common in patients whose closure procedure took less time (p = 0.002) and in those who had a shorter wait from creation to reversal of the stoma (p < 0.0001).

Conclusions

Reversal of loop ileostomy may be associated with significant morbidity and mortality. Increasing the delay from creation to closure may result in fewer complications.There is an increased risk in older patients with more comorbidity, particularly when the primary procedure is for diverticular disease with significant peritoneal contamination.

Notes

Acknowledgments

The authors thank the following surgeons for contributing cases to this study: D. M. Bradburn, J. S. Falconer, L. F. Horgan, M. Jha, S. Mills, D. O’Callaghan, R. Pollard, K. Seehra, K. Seymour, and B. J. Slater.

References

  1. 1.
    Feinberg SM, McLeod RS, Cohen Z (1987) Complications of loop ileostomy. Am J Surg 153(1):102–106PubMedCrossRefGoogle Scholar
  2. 2.
    Gooszen A, Geelkerken RH, Hermans J et al (1998) Temporary decompression after colorectal surgery: randomized comparison of loop ileostomy and loop colostomy. Br J Surg 85(1):76–79PubMedCrossRefGoogle Scholar
  3. 3.
    Khoo REH, Cohen MM, Chapman GM et al (1994) Loop ileostomy for temporary fecal diversion. Am J Surg 167(5):519–522PubMedCrossRefGoogle Scholar
  4. 4.
    Bell C, Asolati M, Hamilton E et al (2005) A comparison of complications associated with colostomy reversal versus ileostomy reversal. Am J Surg 190(5):717–720PubMedCrossRefGoogle Scholar
  5. 5.
    Edwards DP, Donaldson DR, Chisholm EM (1998) Closure of transverse loop colostomy and loop ileostomy. Ann R Coll Surg Engl 80(1):33–35PubMedGoogle Scholar
  6. 6.
    Thalheimer A, Bueter M, Kortuem M et al (2006) Morbidity of temporary loop ileostomy in patients with colorectal cancer. Dis Colon Rectum 49(7):1011–1017PubMedCrossRefGoogle Scholar
  7. 7.
    Wong KS, Remzi FH, Gorgun E et al (2005) Loop ileostomy closure after restorative proctocolectomy: outcome in 1504 patients. Dis Colon Rectum 48(2):243–250PubMedCrossRefGoogle Scholar
  8. 8.
    Hasegawa H, Radley S, Morton DG et al (2000) Stapled versus sutured closure of loop ileostomy. Ann Surg 231(2):202–204PubMedCrossRefGoogle Scholar
  9. 9.
    Bain IM, Keighley MRB, Patel R (1996) Comparison of sutured and stapled closure of loop ileostomy after restorative proctocolectomy. Ann R Coll Surg Engl 78(6):555–556PubMedGoogle Scholar
  10. 10.
    Phang PT, Hain JM, Perez-Ramirez JJ et al (1999) Techniques and complications of ileostomy takedown. Am J Surg 177(6):463–466PubMedCrossRefGoogle Scholar
  11. 11.
    Fasth S, Hultén L (1994) Loop ileostomy: a superior diverting stoma in colorectal surgery. World J Surg 8(3):401–407CrossRefGoogle Scholar
  12. 12.
    Williams NS, Nasmyth DG, Jones D et al (1986) De-functioning stomas: a prospective controlled trial comparing loop ileostomy with loop transverse colostomy. Br J Surg 73(7):566–570PubMedCrossRefGoogle Scholar
  13. 13.
    Van de Pavoordt HDWM, Fazio VW, Jagelman DG et al (1987) The outcome of loop ileostomy closure in 293 cases. Int J Colorectal Dis 2(4):214–217PubMedCrossRefGoogle Scholar
  14. 14.
    O’Toole GC, Hyland JMP, Grant DC et al (1999) Defunctioning loop ileostomy: a prospective audit. J Am Coll Surg 188(1):6–9PubMedCrossRefGoogle Scholar
  15. 15.
    Senapati A, Nicholls RJ, Ritchie JK et al (1993) Temporary loop ileostomy for restorative proctocolectomy. Br J Surg 80(5):628–630PubMedCrossRefGoogle Scholar
  16. 16.
    Amin SM, Memon MA, Armitage NC et al (2001) Defunctioning loop ileostomy and stapled side-to-side closure has low morbidity. Ann R Coll Surg Engl 83(4):246–249PubMedGoogle Scholar
  17. 17.
    Berry DP, Scholefield JH (1997) Closure of loop ileostomy. Br J Surg 84(4):524PubMedCrossRefGoogle Scholar
  18. 18.
    Lewis P, Bartolo DCC (1990) Closure of loop ileostomy after restorative proctocolectomy. Ann R Coll Surg Engl 72(4):263–265PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2008

Authors and Affiliations

  • S. D. Mansfield
    • 1
  • C. Jensen
    • 1
  • A. S. Phair
    • 2
  • O. T. Kelly
    • 2
  • S. B. Kelly
    • 1
  1. 1.Department of General SurgeryNorth Tyneside General HospitalNorth ShieldsUK
  2. 2.University of Newcastle upon Tyne Medical SchoolTyne and WearUK

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